It's been a while since I've blogged.
I didn't have anything new to say and one person alone can't make a large group see sense.
AAHomecare is still a do-nothing association that has little to offer other than self-serving hot air. Our voice in Washington may as well be silenced because it surely has done no good and accomplished absolutely nothing in many years.
NAIMES is still touting that idiotic auction as a solution to our competitive bidding problem. Yes, Wayne Stanfield and company, let's trade one evil for another because that will surely save the industry. That's the dumbest strategy I've ever heard of, and I can't believe that anyone would pay to be a member of an organization that would back such a stupid idea.
Between the two, there isn't one good organization.
The Blind Leading the Blind
Don't worry, I'm not ignoring AMEPA. It was announced some time ago that Rob Brant was stepping down as President and that Barry Johnson was going to take his place. This is not an improvement because I think each man is equally ridiculous.
The AMEPA site still lists Brant as President, and as late as mid-August, Brant was still posting. These guys can't get it together enough to keep their site current.
Brant was "leading" meetings in Texas in August to discuss round two competitive bidding, and he was clearly impressed with the fact that he "committed" two weeks to the "project."
Really? Nothing says "success" like attending meetings "led" by a man who has a failed DME, who was rejected in the first round of round one and who barely managed to snag a single inadequate contract in the reboot, and who fell so spectacularly flat at ridding the industry of bidding. Brant formed AMEPA because he was convinced that he had all the answers. This man scheduled meetings and presumed to tell others how to prepare for bidding and how to engage legislators?
How many of you were gullible enough or desperate enough to fall for his self-proclaimed expertise?
If you want or need guidance, turn to the people who know what they're talking about, not the failures of the industry. I am always amazed and alarmed when I hear that someone has hired a "consultant" who was the owner of a DME that was a failure. Is it a case then of applying the mantra of "do as I say, not as I did?"
I doubt those AMEPA sessions were well-attended, so I'm going to do those who did fall prey to desperation a favor and offer some advice their own common sense should have told them to begin with: Never take advice from someone who wasn't competent to keep his own doors open.
If your consultant wasn't capable in his (or her) own venture, then he (or she) isn't capable in yours.
I Told You So
When the rocket scientists of TAHCS, combined with the equally smart Dean Cheney, came up with the been-there-done-that idea of filing suit to force CMS and HHS to detail the financial standards used in the bidding process, I said here on my blog that this was not going to work.
I was right. Again.
It was entertaining to watch Cheney doing his best imitation of a strutting rooster at industry events after the suit was filed, presenting himself as the underdog brave enough to fight CMS in court. It was amusing to watch Cheney all but beg for attention and praise for putting himself and his company out there; Cheney was a man willing to "take one for the team," and he wanted to make sure all of us knew it.
He had no investment in the case; it's not as though he was funding it. He was merely a front. But that didn't stop Cheney from trying to take as much of the credit and attention that he could grab. He put me in mind of all of the people these days who are famous for doing nothing. Kim Kardashian, anyone?
Anyone paying attention this week saw in HME News that the suit was dismissed because it basically lacked merit. The discretion granted to the Secretary in statute was very clear. Anti-bidding lawsuits don't get results for the industry. The lawyers involved may find it profitable, but in the end, there is no benefit to the DMEs.
Desperate times sometimes call for desperate measures, but how many times can the industry be defeated in court until it realizes that court is not the answer?
So What Is the Answer?
The answer is simple, really.
CMS can't have competitive bidding if the industry refuses to participate in the farce.
This approach requires that we all agree to refuse; this approach requires that each and every company in the round-two areas (even the nationals!) not submit a bid of any kind.
It requires solidarity. And that's why nothing has yet to or will ever work. There's always going to be a few who will have a winner-take-all mentality and submit stupidly low bids in an attempt to secure as many contracts as he (or she) can get. Knowing this, the rest of you will submit bids so you're not left out, and this is why round two and any future rounds will ultimately succeed.
The success of competitive bidding is guaranteed by the very industry so desperate to get rid of it. This ensures the most spectacular epic fail of all.
Wednesday, September 28, 2011
Monday, May 23, 2011
Winners and Losers and Fools (Oh My!)
I haven't had much to say lately because there hasn't been that much going on, and I can only talk about competitive bidding just so much before even I become bored repeating myself.
This morning I had two emails forwarded to me, and I read an article in HME News (print edition, May 2011). I've got something to say about each one.
Winners
The first email sent to me was one from MESA, telling its members that the Texas Comptroller of Public Accounts (TCPA) had announced that it was not going to go through with the competitive bid on incontinence products.
Here, minus the text from the TCPA, is what MESA sent out:
"MESA is very pleased to announce that the procurement initiative, developed and driven by the Texas Comptroller of Public Accounts (TCPA), with the assistance of Texas Health and Human Services Commission (HHSC), has been deemed unnecessary, and is no longer looming over Texas incontinence suppliers.
Persuading the TCPA that the initiative was not in the best interests of the agency or beneficiaries was a team effort, and MESA deeply appreciates the participation of all who helped shape its policy, and all who helped to deflect this initiative.
It is our further understanding that this decision means that this item will be withdrawn from the agenda of the MCAC meeting of June 9. So, it will not be necessary for providers to attend that meeting if their purpose in going was to testify about this particular matter.
Moving forward from this point, MESA looks forward to representing its members as it participates and cooperates with the Texas HHSC in upcoming workgroups, and the implementation of the viable alternatives to competitive procurement."
Though the efforts of MESA to combat the bid were, I'm reliably told, diligent and consistent, there is no chest-beating in their email release, and no claims of being the reason (or the main reason) for the success of defeating the incontinence bid. MESA makes it clear that it was a team effort, and thanks all involved.
MESA is and always has been a class act, and from what I'm able to gather from MESA members I know in Texas, the association was instrumental in stopping the incontinence bid as well as doing a great job representing members with a rate-reduction work-group held in a series of meetings in April.
MESA worked hard; MESA worked well and effectively with others; MESA served its members in Texas very well; and MESA did it all without in-your-face, hooray-for-us posturing.
Losers
By "losers" I mean TAHCS. The other email forwarded to me was the one TAHCS sent out. The first problem with their release is the subject line: TAHCS - WE STOPPED COMPETITIVE BIDDING.
Pardon me while I stop and roll my eyes at that ridiculous bit of fiction. TAHCS stopped competitive bidding? TAHCS can't even get a member base because no one takes them seriously; I doubt the TCPA or the HHSC takes them anymore seriously than the rest of us.
TAHCS was one of many working on the incontinence bid problem. I was intrigued by their claim that representatives of the organization "participated in numerous public and private meetings to address the budget shortfall and how Medicaid would be affected," but then I learned that the meetings to address the budget shortfall had nothing to do with the incontinence bid, and realized that it was TAHCS trying to make themselves look more important and more active than they really are.
Again.
The meetings TAHCS is babbling about in the release were the April HHSC work-groups that MESA and other stakeholders participated in to save money for the state to avoid a totally different bid threat.
I really loved this one:
TAHCS' input began in September 2010 and concluded in April 2011 with our last meeting being with HHSC. "We have been working long and hard to find an alternative to competitive bidding and have been met with some success," said Barry Johnson, President TAHCS.
TAHCS' input began in September 2010 and concluded in April 2011 with our last meeting being with HHSC. "We have been working long and hard to find an alternative to competitive bidding and have been met with some success," said Barry Johnson, President TAHCS.
Others involved can say the same thing (only it would be true in their cases), but I don't recall any word that TAHCS turned in an alternative proposal like MESA did. Barry Johnson, you shouldn't be allowed to communicate without a keeper to make sure what you spout is honest, because every time you and the folks at TAHCS send something out, my BS meter goes wild.
Fools
If you have a copy of the May 2011 edition of HME News, turn to page 13 and read Rob Brant's sob story at the bottom.
It's a shame that competitive bidding puts anyone out of business and that it forces beneficiaries to use different providers. But the truth is that although the current bid system is flawed, any bid system would end up putting some providers out of business.
There are real costs to operating a DME, as Brant rightly pointed out in his little speech at the PAOC meeting. The question in my mind, though, is this: Why did Brant accept a contract if he knew he couldn't afford to do business at the bid rate? How is he more responsible than the out-of-state, inexperienced, or bankrupt companies he rails against?
If Brant knew he couldn't provide oxygen for under $28.77 per month, then accepting a contract with a rate of $21.66 makes absolutely no sense. I understand that he laid off half of his staff and moved into a smaller space. But from the way I read his speech, he knew in July of 2010 that he couldn't operate on what Medicare was willing to pay him. Why delay the inevitable through April of 2011?
Brant didn't get into the industry activism game until mid-2008; he sat on his hands until then, figuring that someone else would do something that he was just too busy with everyday life to do. Eventually it dawned on him that doing nothing was going to have a direct impact on his own wallet, so that's when he launched AMEPA. He proclaimed loudly that AAHomecare wasn't doing the job (they weren't), yet he's been in bed with them for quite some time now, actively assisting them with their failing strategies and policies.
The result? AMEPA has accomplished nothing, and AAHomecare still isn't doing the job. This makes sense; I can offer the following mathematical equation to explain the results from the Brant/AAHomecare match-up:
0 + 0 = 0
Liars may figure, but figures never lie.
Rob Brant, "better late than never" works fine when applied to arriving at parties, but not when your livelihood is on the line and the fight needs every person involved. I don't think that your personal activism earlier on would've saved the industry (you're obviously not saviour material), but if all the people sitting on their dead butts would've been consistently active in 2001 and 2002, the industry might not be in the sorry shape it's in today.
You, Rob Brant, were part of the problem, and it was too late by the time you finally got off the spectators' bench for you to be a part of the solution.
So you'll pardon me for not feeling terribly sorry for you, Rob Brant. I feel sorry for the providers who have been in the trenches for almost a decade and who can't seem to find a win no matter how hard they try because so few fight with them. I feel sorry for the beneficiaries who have had problems with the changes caused by competitive bidding. I feel sorry for the people who have believed in you during the last three years and ended up with nothing to show for that belief but your hot air. But I don't feel sorry for you.
The possible silver lining I see from the shut-down of City Medical, Rob Brant, is that you could end up doing us all a favor by going away.
Please take Barry Johnson with you.
Monday, April 18, 2011
Want Some Cheese With That Whine?
I've heard and read that "someone should do something" about the situation the industry is in.
Tyler Wilson is quoted in HME News as telling DME providers that they need to get involved.
D-U-H!
This isn't news. The whole article is generic, and could have been written at any time during the last eight or nine years. The industry has been told, over and over again, that every one of us needs to be actively and consistently involved.
There are some gems in this particular article; I was especially amused by Walt Gorski saying that we do have influence over lawmakers, and that "steady pressure over time will crack any rock, and, frankly, steady pressure over time makes diamonds."
That cracks me up.
What does Gorski think we've been doing over the last decade? We've tried the steady pressure approach, and has it worked?
Hint: The answer is only "yes" if we've gotten rid of competitive bidding.
Gorski is also quoted as saying that providers need to be vocal about bidding issues, and that "complaints are going to be what drives this program into the ground."
We've been vocal, for years. And though I agree with Gorski that complaints will be what gets rid of bidding, I don't think that it's complaints from our industry that will do the job. The complaints need to come from the beneficiaries in record numbers.
Cut to Hypothetical Round Robin
DME Provider: Congressman X, I don't like competitive bidding, and it's not good for beneficiaries.
Congressman X: How is it not good for beneficiaries?
DME Provider: It inhibits access to care.
Congressman X: You're a caregiver?
DME Provider: I provide important services in the home to patients.
Congressman X: Such as?
DME Provider: Well, I supply the equipment they need at home, which saves the Medicare program millions of dollars each year because my patients aren't in the hospital.
Congressman X: Medical equipment at home is important, but what services do you provide?
DME Provider: I deliver the equipment to their homes; I also take care of repairs if their equipment needs fixing or maintenance.
Congressman X: Sears delivers and honors warranties too. What services do you provide?
DME Provider: My business is on call 24/7 if a beneficiary has an emergency with his equipment.
Congressman X: Well that's a plus. But I've heard from your national association that your industry provides care in the home, and so far what you're telling me is that you provide medical equipment in the home, but no care.
DME Provider: We do set-up, and teach the patient how to operate the equipment we've delivered.
Congressman X: So does Best Buy.
DME Provider: Sir, our costs of business keep going up, but reimbursements are being slashed. The Medicare program requires that we continue to do business according to specific and costly standards, but it's getting harder and harder to do that in these hard economic times. I need your help, and ask you to support legislation that will repeal competitive bidding.
Congressman X: Competitive bidding for DME is expected to save the government $20 billion dollars. We have a deficit of over $14 trillion dollars. We all have to tighten our belts and find ways to cut everywhere we can. I'm a supporter of small businesses, and understand your concerns. But these are tough times, and entitlement programs have to be trimmed too.
DME Provider: Beneficiaries don't like competitive bidding where it's been implemented.
Congressman X: My district is in a round-one bidding area, and my offices haven't had one complaint from any beneficiaries.
DME Provider: But there have been problems at discharge and a lot of confusion. Medicare didn't educate the public or hospitals or doctors adequately.
Congressman X: My understanding is that these situations have tapered off, and that things are running more smoothly now. Any new program is going to have bumps in the road, especially programs as big as competitive bidding. CMS tells Congress that the competitive bidding is saving money and that beneficiaries are receiving the products they need at better prices. Fraud is also being drastically reduced in the bid areas, and that's going to save the program money too.
DME Provider: Sir, with all due respect, the reimbursements in the bid areas are too low. They're going to drive many of the bid winners out of business.
Congressman X: But the reimbursement rates were arrived at by the amounts providers themselves bid. How can the rates be too low?
DME Provider: We call the people who bid too low in an effort to secure contracts and make up for the low reimbursements in bulk "suicide bidders." CMS didn't do enough to eliminate those bids from the program, and because of that the rates are too low. The agency said that bids too low would be thrown out, but that didn't seem to happen, and now my industry is suffering. CMS should have done a better job.
Congressman X: How is CMS responsible for the unsound bids submitted by the industry's businesses?
DME Provider: CMS should have known those bids were too low and rejected them.
Congressman X: CMS has to work with what it's given. If the agency was given low bids, then the final reimbursements would be low. The responsibility for that lies with the bidders. But let me ask you this: lower reimbursements mean lower co-pays for beneficiaries, don't they?
DME Provider: Yes, beneficiaries have a reduced co-pay for the products and care we provide to them.
Congressman X: What care?
Does that conversation seem ridiculous? It shouldn't, because I've had several like it. Legislators and their aides are always polite and respectful, but if they're familiar with the program, and they have even a vague understanding of the industry, they know what we're going to say before we say it.
Our arguments against bidding are so thin they're almost threadbare.
We can't expect the repeal of a program that is expected to save the government $20 billion, especially if we don't have a pay-for to offer. It's nice of Dean Rosen, yet another lobbyist that AAHomecare is paying, to tell us that we need to be part of the solution (thanks for doing what AAHomecare does best by pointing out the obvious, Dean), but we have nothing to offer because we have no cohesive plan compounded by pathetic leadership.
Round Two Delay
For those of you heartened by the delay, don't be. Though CMS is talking "potential structural changes," the fact is that a "changed" competitive bidding is still competitive bidding. Team Credibility at AAHomecare might be trying to tell us that the delay gives us a chance to get more support for HR 1041, but the truth is the political climate is unfavorable to us, and without big support in the Senate, this year's bill will fail just like last year's bill.
I believe in hope, though it may appear that I don't. But I don't believe in false hope. HR 1041 is, to me, AAHomecare trying to look busy, and I'm not buying into it; I'm smarter than that.
Pity Party
Poor Rob Brant. He's going to close his business at the end of this month.
It's not as though he was that invested in his business lately; Brant had moved to Atlanta. How does one "manage" and nurture a small business in Miami from Atlanta?
Oh, that's right. Brant was more interested in his 15 minutes of annoying those of us in the industry who have taste and who can think on our own.
I've said it before and I'll say it again: If Brant and his cronies, along with a lot of other worthless do-nothings, had gotten involved in the fight before 2008, we might be experiencing a different, more friendly reality today. No, I'm not implying that Brant would have ended up the savior he's made himself out to be; that's a concept that's too ridiculous. But he sat on his hands until it was far too late.
Brant has been abrasive, arrogant, and annoying. He has oozed his way into the limelight, and has managed to smarm himself onto the AAHomecare board. With the closing of his business, he ought to go find something else to do and give the rest of us some peace. He should take Barry Johnson and Dean Cheney with him, too, but we won't get so lucky. My guess is that Brant is going to sell himself as some kind of industry expert and charge for consulting. Or, worse yet, become a lobbyist, which his track record of success would clearly support. Not.
It hurts when I laugh that hard.
Whine and Cheese
When we talk to legislators or aides, we can't make the same pitch we've been making for year and years. We can't sustain the myth that we provide care in the home. If the beneficiaries aren't behind us, we're spinning our wheels. Our strategy needs to be focused on them; our mission is to get them motivated and vocal. We can contact our legislators and storm the Hill all we like; we're not a strong enough lobby on our own. Until the beneficiaries are doing it with us, we're going to go nowhere fast, so that's where we need to focus our efforts. We need to get them good and mad.
Tyler Wilson is quoted in HME News as telling DME providers that they need to get involved.
D-U-H!
This isn't news. The whole article is generic, and could have been written at any time during the last eight or nine years. The industry has been told, over and over again, that every one of us needs to be actively and consistently involved.
There are some gems in this particular article; I was especially amused by Walt Gorski saying that we do have influence over lawmakers, and that "steady pressure over time will crack any rock, and, frankly, steady pressure over time makes diamonds."
That cracks me up.
What does Gorski think we've been doing over the last decade? We've tried the steady pressure approach, and has it worked?
Hint: The answer is only "yes" if we've gotten rid of competitive bidding.
Gorski is also quoted as saying that providers need to be vocal about bidding issues, and that "complaints are going to be what drives this program into the ground."
We've been vocal, for years. And though I agree with Gorski that complaints will be what gets rid of bidding, I don't think that it's complaints from our industry that will do the job. The complaints need to come from the beneficiaries in record numbers.
Cut to Hypothetical Round Robin
DME Provider: Congressman X, I don't like competitive bidding, and it's not good for beneficiaries.
Congressman X: How is it not good for beneficiaries?
DME Provider: It inhibits access to care.
Congressman X: You're a caregiver?
DME Provider: I provide important services in the home to patients.
Congressman X: Such as?
DME Provider: Well, I supply the equipment they need at home, which saves the Medicare program millions of dollars each year because my patients aren't in the hospital.
Congressman X: Medical equipment at home is important, but what services do you provide?
DME Provider: I deliver the equipment to their homes; I also take care of repairs if their equipment needs fixing or maintenance.
Congressman X: Sears delivers and honors warranties too. What services do you provide?
DME Provider: My business is on call 24/7 if a beneficiary has an emergency with his equipment.
Congressman X: Well that's a plus. But I've heard from your national association that your industry provides care in the home, and so far what you're telling me is that you provide medical equipment in the home, but no care.
DME Provider: We do set-up, and teach the patient how to operate the equipment we've delivered.
Congressman X: So does Best Buy.
DME Provider: Sir, our costs of business keep going up, but reimbursements are being slashed. The Medicare program requires that we continue to do business according to specific and costly standards, but it's getting harder and harder to do that in these hard economic times. I need your help, and ask you to support legislation that will repeal competitive bidding.
Congressman X: Competitive bidding for DME is expected to save the government $20 billion dollars. We have a deficit of over $14 trillion dollars. We all have to tighten our belts and find ways to cut everywhere we can. I'm a supporter of small businesses, and understand your concerns. But these are tough times, and entitlement programs have to be trimmed too.
DME Provider: Beneficiaries don't like competitive bidding where it's been implemented.
Congressman X: My district is in a round-one bidding area, and my offices haven't had one complaint from any beneficiaries.
DME Provider: But there have been problems at discharge and a lot of confusion. Medicare didn't educate the public or hospitals or doctors adequately.
Congressman X: My understanding is that these situations have tapered off, and that things are running more smoothly now. Any new program is going to have bumps in the road, especially programs as big as competitive bidding. CMS tells Congress that the competitive bidding is saving money and that beneficiaries are receiving the products they need at better prices. Fraud is also being drastically reduced in the bid areas, and that's going to save the program money too.
DME Provider: Sir, with all due respect, the reimbursements in the bid areas are too low. They're going to drive many of the bid winners out of business.
Congressman X: But the reimbursement rates were arrived at by the amounts providers themselves bid. How can the rates be too low?
DME Provider: We call the people who bid too low in an effort to secure contracts and make up for the low reimbursements in bulk "suicide bidders." CMS didn't do enough to eliminate those bids from the program, and because of that the rates are too low. The agency said that bids too low would be thrown out, but that didn't seem to happen, and now my industry is suffering. CMS should have done a better job.
Congressman X: How is CMS responsible for the unsound bids submitted by the industry's businesses?
DME Provider: CMS should have known those bids were too low and rejected them.
Congressman X: CMS has to work with what it's given. If the agency was given low bids, then the final reimbursements would be low. The responsibility for that lies with the bidders. But let me ask you this: lower reimbursements mean lower co-pays for beneficiaries, don't they?
DME Provider: Yes, beneficiaries have a reduced co-pay for the products and care we provide to them.
Congressman X: What care?
Does that conversation seem ridiculous? It shouldn't, because I've had several like it. Legislators and their aides are always polite and respectful, but if they're familiar with the program, and they have even a vague understanding of the industry, they know what we're going to say before we say it.
Our arguments against bidding are so thin they're almost threadbare.
We can't expect the repeal of a program that is expected to save the government $20 billion, especially if we don't have a pay-for to offer. It's nice of Dean Rosen, yet another lobbyist that AAHomecare is paying, to tell us that we need to be part of the solution (thanks for doing what AAHomecare does best by pointing out the obvious, Dean), but we have nothing to offer because we have no cohesive plan compounded by pathetic leadership.
Round Two Delay
For those of you heartened by the delay, don't be. Though CMS is talking "potential structural changes," the fact is that a "changed" competitive bidding is still competitive bidding. Team Credibility at AAHomecare might be trying to tell us that the delay gives us a chance to get more support for HR 1041, but the truth is the political climate is unfavorable to us, and without big support in the Senate, this year's bill will fail just like last year's bill.
I believe in hope, though it may appear that I don't. But I don't believe in false hope. HR 1041 is, to me, AAHomecare trying to look busy, and I'm not buying into it; I'm smarter than that.
Pity Party
Poor Rob Brant. He's going to close his business at the end of this month.
It's not as though he was that invested in his business lately; Brant had moved to Atlanta. How does one "manage" and nurture a small business in Miami from Atlanta?
Oh, that's right. Brant was more interested in his 15 minutes of annoying those of us in the industry who have taste and who can think on our own.
I've said it before and I'll say it again: If Brant and his cronies, along with a lot of other worthless do-nothings, had gotten involved in the fight before 2008, we might be experiencing a different, more friendly reality today. No, I'm not implying that Brant would have ended up the savior he's made himself out to be; that's a concept that's too ridiculous. But he sat on his hands until it was far too late.
Brant has been abrasive, arrogant, and annoying. He has oozed his way into the limelight, and has managed to smarm himself onto the AAHomecare board. With the closing of his business, he ought to go find something else to do and give the rest of us some peace. He should take Barry Johnson and Dean Cheney with him, too, but we won't get so lucky. My guess is that Brant is going to sell himself as some kind of industry expert and charge for consulting. Or, worse yet, become a lobbyist, which his track record of success would clearly support. Not.
It hurts when I laugh that hard.
Whine and Cheese
When we talk to legislators or aides, we can't make the same pitch we've been making for year and years. We can't sustain the myth that we provide care in the home. If the beneficiaries aren't behind us, we're spinning our wheels. Our strategy needs to be focused on them; our mission is to get them motivated and vocal. We can contact our legislators and storm the Hill all we like; we're not a strong enough lobby on our own. Until the beneficiaries are doing it with us, we're going to go nowhere fast, so that's where we need to focus our efforts. We need to get them good and mad.
Thursday, April 14, 2011
MSNBC Strikes Again
An article on MSNBC today has once again demonstrated the site's genius for pointing out the obvious in an article called "Florida is 'Ground Zero' for Healthcare Fraud."
That's almost as dumb as HomeCare Magazine's tendency to seek out Rob Brant and Barry Johnson for pearls of wisdom they're so obviously ill-equipped to provide.
MSNBC and NBC reporters seem to like doing stories about Medicare fraud in Florida. We all know about the fraud problems in that state; it's a mecca for retirees, so of course there will be more fraud there than, say, Wisconsin. Or Alaska. I think it's fair to say that where there are large number of beneficiaries, the chances that fraud will be committed increase.
It's useless to try to tell the press to use more current statistics, and it's pointless to tell them how our industry is being beaten up by competitive bidding and all the requirements we've been slapped with the last couple of years. The article zooms in on Miami, and rightfully so; Miami has long been notorious for Medicare fraud, and is probably responsible for a large part of the industry's awful reputation. Yes, other cities in other areas have contributed (Houston, for example), but Miami is king when it comes to fraud.
I'll probably get some complaints from Miami providers, but don't wait for an apology. Cliches exist for a reason, and where there's smoke there's fire. I don't know what the fraud stats are for Orlando, but I was completely unsurprised when Miami was in round one of competitive bidding. I think I might have been outraged if it hadn't been.
The article tells us that Medicare systems were set up and run on the assumption that those billing are honest; though the writer points out the flaws in agency staff, those billing are, of course, the bad guys of the story. What's wrong about that is that there are honest people who provide products and submit for reimbursement.
We know that back in the day, being in DME was lucrative, and business owners made a tidy sum from Medicare. But fraud isn't new, and it's taken CMS an incredibly long time to make changes that will enable them to fight the drain more effectively. If a company is billing for an unusual number of, say, left arm prosthetics, and it's not caught, then the system isn't run or policed well.
One the one hand, it's terrible that CMS seems to be able to evade responsibility for not doing more sooner. On the other hand, it's almost tragic that there are people out there actively looking for ways to beat the system and stick it to the taxpayer. The only thing wrong with assuming honesty is overlooking the fact that there's a lot of larceny out there.
Sometimes you can't appeal to a person's better nature because the person in question simply doesn't have a better nature. The entitlement mentality has taken a stranglehold on a huge portion of this country's population, and to those people, getting something for nothing is their right because they think it's owed to them.
When did that happen to us? My parents didn't raise me that way, and I didn't raise my children that way. I appear to be an exception rather than the rule; I can't go anywhere anymore without children running wild and their parents ignoring them or asking them to behave instead of making them act like people instead of animals. During the last twenty years, the trend in parenting has been to be "friends"' with your children instead of parents; we're told to not scar the little darlings by imposing punishment, and making them face consequences for their actions is a shocking idea anymore.
If the government thinks it's having a hard time with fraud now, I shudder to think of what's going to happen as the youngsters in this country come of age.
I'm not saying anything most of you haven't thought privately, but no one talks about it and no one does anything about it. And it's sad, because it's a symptom of the decline of our society and our country.
So there are more investigators on the streets now to combat the fraud problem. The people who go into business to commit fraud know the risks; they're sure they won't get caught, but they know the risks, and I'm guessing that the police don't frighten them because of the lure of a big (and unearned) payday.
It's important to catch the bad guys. But it's more important to fix the system that the bad guys target. CMS has wasted more than a decade doing nothing except pointing the finger at everyone else but the agency staff and agency subcontractors who know a problem exists but do nothing worthwhile to stop it.
I don't see competitive bidding as worthwhile. Deliberately depopulating an industry via a flawed program in the name of reducing fraud is ridiculous. I'm ignoring the "savings" associated with bidding because CMS has always been in control of reimbursement rates; if they wanted to save money, all they had to do was change the fee schedules.
The slant in fraud articles is painfully obvious. There is no more unbiased journalism anymore, and I'm tired of it. Reporters almost always fail to have any meaningful dialogue with anyone in the industry; our side of the story is almost never told. I don't want the press talking with anyone at AAHomecare or, worse yet, Rob Brant and (or) Barry Johnson (or anyone from that group), because they don't accurately or adequately represent DMEs (some of them are actually embarrassing). I don't want to read anymore vapid quotes from the usual suspects; we don't need trite, and we don't need to feed the egos of the hollow who look only to serve their own interests and further their own agendas.
I vaguely recall that AAHomecare had hired a PR firm not too long ago to improve the industry's image. I don't know how much that firm was paid, but I haven't seen a single positive result from that investment; it's yet another failure in a list of failures brought to us by AAHomecare. Our "voice in Washington," which has no credibility on the hill, can't even buy us a better image.
Epic fail, AAHomecare. Again.
I don't know what the answer is. But I'm frustrated, and very sick of being the victim of a smear campaign conducted by CMS and the press. Maybe I'll take action by contacting the MSNBC advertisers and telling them I'll boycott them if they continue to advertise on a site that runs stories that are half-true.
It's somewhere to start.
That's almost as dumb as HomeCare Magazine's tendency to seek out Rob Brant and Barry Johnson for pearls of wisdom they're so obviously ill-equipped to provide.
MSNBC and NBC reporters seem to like doing stories about Medicare fraud in Florida. We all know about the fraud problems in that state; it's a mecca for retirees, so of course there will be more fraud there than, say, Wisconsin. Or Alaska. I think it's fair to say that where there are large number of beneficiaries, the chances that fraud will be committed increase.
It's useless to try to tell the press to use more current statistics, and it's pointless to tell them how our industry is being beaten up by competitive bidding and all the requirements we've been slapped with the last couple of years. The article zooms in on Miami, and rightfully so; Miami has long been notorious for Medicare fraud, and is probably responsible for a large part of the industry's awful reputation. Yes, other cities in other areas have contributed (Houston, for example), but Miami is king when it comes to fraud.
I'll probably get some complaints from Miami providers, but don't wait for an apology. Cliches exist for a reason, and where there's smoke there's fire. I don't know what the fraud stats are for Orlando, but I was completely unsurprised when Miami was in round one of competitive bidding. I think I might have been outraged if it hadn't been.
The article tells us that Medicare systems were set up and run on the assumption that those billing are honest; though the writer points out the flaws in agency staff, those billing are, of course, the bad guys of the story. What's wrong about that is that there are honest people who provide products and submit for reimbursement.
We know that back in the day, being in DME was lucrative, and business owners made a tidy sum from Medicare. But fraud isn't new, and it's taken CMS an incredibly long time to make changes that will enable them to fight the drain more effectively. If a company is billing for an unusual number of, say, left arm prosthetics, and it's not caught, then the system isn't run or policed well.
One the one hand, it's terrible that CMS seems to be able to evade responsibility for not doing more sooner. On the other hand, it's almost tragic that there are people out there actively looking for ways to beat the system and stick it to the taxpayer. The only thing wrong with assuming honesty is overlooking the fact that there's a lot of larceny out there.
Sometimes you can't appeal to a person's better nature because the person in question simply doesn't have a better nature. The entitlement mentality has taken a stranglehold on a huge portion of this country's population, and to those people, getting something for nothing is their right because they think it's owed to them.
When did that happen to us? My parents didn't raise me that way, and I didn't raise my children that way. I appear to be an exception rather than the rule; I can't go anywhere anymore without children running wild and their parents ignoring them or asking them to behave instead of making them act like people instead of animals. During the last twenty years, the trend in parenting has been to be "friends"' with your children instead of parents; we're told to not scar the little darlings by imposing punishment, and making them face consequences for their actions is a shocking idea anymore.
If the government thinks it's having a hard time with fraud now, I shudder to think of what's going to happen as the youngsters in this country come of age.
I'm not saying anything most of you haven't thought privately, but no one talks about it and no one does anything about it. And it's sad, because it's a symptom of the decline of our society and our country.
So there are more investigators on the streets now to combat the fraud problem. The people who go into business to commit fraud know the risks; they're sure they won't get caught, but they know the risks, and I'm guessing that the police don't frighten them because of the lure of a big (and unearned) payday.
It's important to catch the bad guys. But it's more important to fix the system that the bad guys target. CMS has wasted more than a decade doing nothing except pointing the finger at everyone else but the agency staff and agency subcontractors who know a problem exists but do nothing worthwhile to stop it.
I don't see competitive bidding as worthwhile. Deliberately depopulating an industry via a flawed program in the name of reducing fraud is ridiculous. I'm ignoring the "savings" associated with bidding because CMS has always been in control of reimbursement rates; if they wanted to save money, all they had to do was change the fee schedules.
The slant in fraud articles is painfully obvious. There is no more unbiased journalism anymore, and I'm tired of it. Reporters almost always fail to have any meaningful dialogue with anyone in the industry; our side of the story is almost never told. I don't want the press talking with anyone at AAHomecare or, worse yet, Rob Brant and (or) Barry Johnson (or anyone from that group), because they don't accurately or adequately represent DMEs (some of them are actually embarrassing). I don't want to read anymore vapid quotes from the usual suspects; we don't need trite, and we don't need to feed the egos of the hollow who look only to serve their own interests and further their own agendas.
I vaguely recall that AAHomecare had hired a PR firm not too long ago to improve the industry's image. I don't know how much that firm was paid, but I haven't seen a single positive result from that investment; it's yet another failure in a list of failures brought to us by AAHomecare. Our "voice in Washington," which has no credibility on the hill, can't even buy us a better image.
Epic fail, AAHomecare. Again.
I don't know what the answer is. But I'm frustrated, and very sick of being the victim of a smear campaign conducted by CMS and the press. Maybe I'll take action by contacting the MSNBC advertisers and telling them I'll boycott them if they continue to advertise on a site that runs stories that are half-true.
It's somewhere to start.
Tuesday, March 22, 2011
Plan Z
The usual feel-good spin has begun.
You Spin Me Right 'Round Baby Right 'Round
I don't mind feeling good; in fact, I'm strongly in favor of it. But what I don't like is when my hopes are raised and then dashed because there's no substance behind the spin that raised them in the first place.
So I'm skeptical, but not unjustly so.
We've all been down the legislative road trying to get competitive bidding repealed. And we've all seen just how successful those efforts were.
I actually get angry when I read articles in the industry press that offer a sunshine-and-kittens take on the latest bill to be introduced in the House of Representatives.
HME News trumpets that it looks like "providers had the luck of the Irish" during AAHomecare's ridiculous legislative conference; the article has Tyler Wilson gushing about how the bill has "infused the conference with excitement" (pardon me while I gag), and one of the bill's authors (Thompson) telling the industry to "put a face" on the issue and "really drive it home."
Hold on a second; I need to gag again.
The latest bill that Tyler Wilson really needs to succeed isn't anything new. Anyone out there who believes that any bill introduced that's meant to repeal competitive bidding and doesn't have some kind of cost to the industry is an idiot. Altmire and Thompson want to use money set aside for other projects that was never spent as a pay-for? I'll believe it when I see it happen, and here's why: There are more pressing things that our government could use that money on. Getting rid of competitive bidding is important, but I can think of several things to spend "spare" money on, and I'm betting that there are others who want to use that money too.
Does our government really have any "spare" money? We have an enormous deficit. Our government cannot and should not continue to spend money it doesn't have. Not even to serve a special interest.
Thompson tells us to put a face on the issues. What does that man think we've been doing since before MMA 2003? Year after year we've marched to the Hill and made the rounds trying to put a face on the issue and to really drive it home. And every year we've failed.
So I looked at what HomeCare Monday had to say about the bill; I'm going to start off by giving them a very black mark for quoting Rob Brant.
Thank you, Rob, for once again pointing out the obvious; the village idiot could figure out that the industry needs to get previous supporters signed on again, and that we need as many of the freshmen Reps as we can get too.
What would we do without you, Rob Brant? And thanks so much, HomeCare Monday, for turning to Brant for yet another vapid quote. I suppose I could be grateful that you didn't quote Tyler Wilson, but the truth is that though I think neither Brant nor Wilson is credible (or useful), Wilson has a tiny bit more standing than Brant.
Where's the Love?
The industry can probably get a decent number of supporters in the House. Unlike Senators, Representatives have districts, and so they have a smaller gene pool of voters to rely on for re-election. Representatives need to be more engaged because they can't pull voters from the whole state.
If this new bill doesn't get support in the Senate, it's as dead as last year's bill. So though AAHomecare, NAIMES, and the industry press are putting a positive spin on the legislation, the fact is that it's probable that we're going to get as far this year as we did last year.
Failure is still failure, and we don't appear to have any friends in the Senate.
One person quoted in HomeCare Monday said that there were 250 at the conference, but there should've been 2,500 there.
That may be true, but that conference is expensive, and in the end, it has never led the industry to any kind of victory. Yes, it's an event that has one portion designed to get attendees on the Hill to lobby. But where has that lobbying gotten us? Who among us can really afford to invest in something that offers no return? I see AAHomecare's legislative conference as a cash cow for the association. I've attended it, and I've lobbied during it, and nothing has changed.
So if AAHomecare isn't "feeling the love" through event attendance, it has only itself to blame.
The Warrior
I concede that the current effort has to be made. I do not, however, have any faith in our industry "leaders" to steer it to a successful end. It's their pesky track record, you see, that makes me look at them with a complete lack of confidence.
Giving feel-good, rah-rah snippets doesn't make me enthusiastic about our chances, because I see this maneuver as a rerun of previous identical maneuvers. I see this as doing the same thing over again and expecting different results.
As far as I can tell, AAHomecare still has no "hand" in D.C. I continue to see posers (I'm talking to you, Rob Brant) trying to appear worthy and intelligent (good luck with that). And I see too many state association leaders still mindlessly following and publicly supporting the agenda of AAHomecare; the one that's let us down again and again and again.
I prefer more backbone and more independent thinking in my state (or regional) association leaders, but it would appear that that is a very rare commodity. There are one or two out there who don't have the flock-of-sheep mentality (I've heard from some of its members that MESA has no problem telling AAHomecare what it thinks, and if that's true I wish it was a virus that others would catch), and at the end of the day, the members of the associations suffer from the failure of state leadership to take a stand and demand accountability of the ones presuming to lead in the national arena.
It's not true that a bad leader is better than no leader. We've had a decade of bad leadership, and the proof of that is where we find ourselves today. We need a warrior.
Under Pressure
"These are the days it never rains but it pours." We have to give ourselves one more chance, because to do nothing is to give up. But to do the same thing we did before -- and that resulted in failure -- isn't going to do the job. We need a Plan Z, and we need it fast. We shouldn't rely on just one action initiated by flawed leadership, or we'll waste yet another chance.
Like we can afford that.
You Spin Me Right 'Round Baby Right 'Round
I don't mind feeling good; in fact, I'm strongly in favor of it. But what I don't like is when my hopes are raised and then dashed because there's no substance behind the spin that raised them in the first place.
So I'm skeptical, but not unjustly so.
We've all been down the legislative road trying to get competitive bidding repealed. And we've all seen just how successful those efforts were.
I actually get angry when I read articles in the industry press that offer a sunshine-and-kittens take on the latest bill to be introduced in the House of Representatives.
HME News trumpets that it looks like "providers had the luck of the Irish" during AAHomecare's ridiculous legislative conference; the article has Tyler Wilson gushing about how the bill has "infused the conference with excitement" (pardon me while I gag), and one of the bill's authors (Thompson) telling the industry to "put a face" on the issue and "really drive it home."
Hold on a second; I need to gag again.
The latest bill that Tyler Wilson really needs to succeed isn't anything new. Anyone out there who believes that any bill introduced that's meant to repeal competitive bidding and doesn't have some kind of cost to the industry is an idiot. Altmire and Thompson want to use money set aside for other projects that was never spent as a pay-for? I'll believe it when I see it happen, and here's why: There are more pressing things that our government could use that money on. Getting rid of competitive bidding is important, but I can think of several things to spend "spare" money on, and I'm betting that there are others who want to use that money too.
Does our government really have any "spare" money? We have an enormous deficit. Our government cannot and should not continue to spend money it doesn't have. Not even to serve a special interest.
Thompson tells us to put a face on the issues. What does that man think we've been doing since before MMA 2003? Year after year we've marched to the Hill and made the rounds trying to put a face on the issue and to really drive it home. And every year we've failed.
So I looked at what HomeCare Monday had to say about the bill; I'm going to start off by giving them a very black mark for quoting Rob Brant.
Thank you, Rob, for once again pointing out the obvious; the village idiot could figure out that the industry needs to get previous supporters signed on again, and that we need as many of the freshmen Reps as we can get too.
What would we do without you, Rob Brant? And thanks so much, HomeCare Monday, for turning to Brant for yet another vapid quote. I suppose I could be grateful that you didn't quote Tyler Wilson, but the truth is that though I think neither Brant nor Wilson is credible (or useful), Wilson has a tiny bit more standing than Brant.
Where's the Love?
The industry can probably get a decent number of supporters in the House. Unlike Senators, Representatives have districts, and so they have a smaller gene pool of voters to rely on for re-election. Representatives need to be more engaged because they can't pull voters from the whole state.
If this new bill doesn't get support in the Senate, it's as dead as last year's bill. So though AAHomecare, NAIMES, and the industry press are putting a positive spin on the legislation, the fact is that it's probable that we're going to get as far this year as we did last year.
Failure is still failure, and we don't appear to have any friends in the Senate.
One person quoted in HomeCare Monday said that there were 250 at the conference, but there should've been 2,500 there.
That may be true, but that conference is expensive, and in the end, it has never led the industry to any kind of victory. Yes, it's an event that has one portion designed to get attendees on the Hill to lobby. But where has that lobbying gotten us? Who among us can really afford to invest in something that offers no return? I see AAHomecare's legislative conference as a cash cow for the association. I've attended it, and I've lobbied during it, and nothing has changed.
So if AAHomecare isn't "feeling the love" through event attendance, it has only itself to blame.
The Warrior
I concede that the current effort has to be made. I do not, however, have any faith in our industry "leaders" to steer it to a successful end. It's their pesky track record, you see, that makes me look at them with a complete lack of confidence.
Giving feel-good, rah-rah snippets doesn't make me enthusiastic about our chances, because I see this maneuver as a rerun of previous identical maneuvers. I see this as doing the same thing over again and expecting different results.
As far as I can tell, AAHomecare still has no "hand" in D.C. I continue to see posers (I'm talking to you, Rob Brant) trying to appear worthy and intelligent (good luck with that). And I see too many state association leaders still mindlessly following and publicly supporting the agenda of AAHomecare; the one that's let us down again and again and again.
I prefer more backbone and more independent thinking in my state (or regional) association leaders, but it would appear that that is a very rare commodity. There are one or two out there who don't have the flock-of-sheep mentality (I've heard from some of its members that MESA has no problem telling AAHomecare what it thinks, and if that's true I wish it was a virus that others would catch), and at the end of the day, the members of the associations suffer from the failure of state leadership to take a stand and demand accountability of the ones presuming to lead in the national arena.
It's not true that a bad leader is better than no leader. We've had a decade of bad leadership, and the proof of that is where we find ourselves today. We need a warrior.
Under Pressure
"These are the days it never rains but it pours." We have to give ourselves one more chance, because to do nothing is to give up. But to do the same thing we did before -- and that resulted in failure -- isn't going to do the job. We need a Plan Z, and we need it fast. We shouldn't rely on just one action initiated by flawed leadership, or we'll waste yet another chance.
Like we can afford that.
Monday, March 14, 2011
The Blind Leading the Blind Times Two
Over the weekend someone forwarded an E-mail to me that urged providers to attend a "mock auction" that an economist, Peter Cramton, is holding.
NAIMES has been asking people to go, telling them that it's urgent because "it may be the only chance we have to show that an auction will not work for healthcare. We must be there to share the variables and help Cramton understand the DME industry."
Really?
Cramton isn't going to do this to show that an auction that he favors won't work. He's wanting to do a demonstration of how competitive bidding can work. This mock auction isn't a forum for DME providers to make themselves heard; with all the lobbying that's been done over the last eight-plus years, we've had a ridiculous number of opportunities to say what we've had to say.
There is a difference between not being heard and not being listened to.
Cramton thinks he can show CMS a better way to do bidding. He is not telling CMS that bidding won't work for healthcare. DME providers attending this farce are sending one message and one message only, and that's that the industry supports Cramton's take on bidding.
Readers, if CMS was truly interested in what providers had to say, the agency would've been more responsive to us. Round one has rolled out, and CMS is telling everyone what a great program it is. If CMS is showing interest in Cramton's mock auction, they're doing so not to support a repeal, but to get ideas for future rounds.
One state association leader calls Cramton's work "too important to ignore."
Huh?
Cramton's work is only "important" in that its premise is that the current program won't work as is. And that's where the "importance" of the work ends. Cramton is not our industry's champion; he's out to prove that his version of bidding is better.
Do you support that? I don't. I want competitive bidding repealed, not retooled. The mock auction is not about making ourselves heard, and it's not about making CMS rethink competitive bidding. Industry providers and industry "leaders" can attend this event and make noise when they don't like something, but that's not going to change the focus of the event and it's not going to give us any advantage.
One "leader" said something about the mock auction being an opportunity to have a "discussion."It's not an industry-designed or industry-hosted event. It's an event that people are expected to pay to attend (at $80.00 per person, which no doubt goes into Mr. Cramton's pocket; it's nice of us to line the pockets of a man who wants to teach CMS to build a stronger program) for the privilege of seeing an economist tell CMS how to continue to make it impossible for us to do business.
A discussion? I won't name the "state leader" who came up with that bit of brilliance (this time). But considering how often the individual in question waffles and sucks up to AAHomecare, I guess I'm not surprised. Disappointed, but not surprised. He should be ashamed.
I think that any right-thinking person should boycott this and focus on telling legislators that we are opposed to the continuation of competitive bidding in any form; even that of Peter Cramton.
And I think that any industry "leader" who supports Cramton should be a leader no more.
Speaking of Leaders ...
AAHomecare is doing what it's always done but has never gotten results from.
I've always defined insanity as doing the same thing over and over again but expecting different results.
AAHomecare has persuaded yet another Representative to introduce what's being called a "budget-neutral" bill that will repeal competitive bidding.
Deja vu!!
How many of the past bills to repeal the program have been successful? I can count them on the toes of one hand.
So those of you who are storming D.C. will be able to ask your Representatives to support the bill. And Tyler Wilson is patting himself on the back, expecting the industry to think that he and AAHomecare are the greatest things since sliced bread.
The last bill, introduced by Meek, got 259 supporters, but never got out of committee and never got a single Senator willing to touch it. AAHomecare is saying that people can now go to legislators and talk about the "real" problems with round one: problems with access, confusion, and extra costs because patients can't be discharged as quickly.
Readers, the program was implemented January 1st. We're now in the middle of March. Did anyone honestly expect that implementation of a program so big would have no hiccups? I read about the "problems" in the industry press and from other industry-sympathetic sources, but I have to ask myself this: Are the number of problems increasing? Are they decreasing?
In the long run, competitive bidding will save the Medicare program and beneficiaries money. Lower reimbursements mean lower co-pays, and so seniors aren't shelling out as much if they don't have co-pay coverage.
I don't see how any bill that repeals competitive bidding can begin to be "budget-neutral," and fully expect that the score the legislation will receive will show that my skepticism is right, unless the intent is to slash reimbursements as the pay-for. I don't know about you, but my rising costs of doing business don't allow me to continue to do business by making less money.
I won't need competitive bidding in my area to put me out of business if the already-low reimbursements are cut even more. That's the harsh reality of DME, and people who have no experience running a DME (I'm talking to you, Tyler Wilson) shouldn't be making promises and deals on my behalf that I'm very sure I can't afford. People who answer to boards ruled by big companies with far deeper pockets than I have just don't have a firm grip on the difficulties of running a small industry business, and I'm not interested in following those types (I'm still talking to you, Tyler Wilson).
Do I want to see competitive bidding repealed? Yes. Do I think that AAHomecare's latest attempt at a bill will succeed? No. AAHomecare has handed the industry failure after failure, and I don't see that they've done anything new that's going to change the association's losing streak. I think they're ineffective, and history bears out my judgment.
Too Many Problems and No Solutions
AAHomecare isn't the answer; Peter Cramton and his "mock auction" isn't the answer. I'm going to try to ignore Tyler Wilson and his "go me" posturing; I recognize a bunch of hot air when I hear it.
I'm absolutely boycotting Cramton's event, because I don't want my presence to be construed as supporting a revised method of bidding that might actually work.
I want to serve my patients and earn an honest living. I know that I have to be involved to get rid of competitive bidding, but I'm not interested in doing the same things over and over again and expecting different results. I don't know what the solution is, but I know what -- and who -- hasn't worked, and I don't think it's unreasonable of me to think what I do.
What troubles me are the people who will believe in yet another bill and who will believe that they're going to "be heard" at Cramton's event, and that things will change as a result.
I don't like being let down, and so I choose to travel the road of realism. I don't put my faith in false prophets.
NAIMES has been asking people to go, telling them that it's urgent because "it may be the only chance we have to show that an auction will not work for healthcare. We must be there to share the variables and help Cramton understand the DME industry."
Really?
Cramton isn't going to do this to show that an auction that he favors won't work. He's wanting to do a demonstration of how competitive bidding can work. This mock auction isn't a forum for DME providers to make themselves heard; with all the lobbying that's been done over the last eight-plus years, we've had a ridiculous number of opportunities to say what we've had to say.
There is a difference between not being heard and not being listened to.
Cramton thinks he can show CMS a better way to do bidding. He is not telling CMS that bidding won't work for healthcare. DME providers attending this farce are sending one message and one message only, and that's that the industry supports Cramton's take on bidding.
Readers, if CMS was truly interested in what providers had to say, the agency would've been more responsive to us. Round one has rolled out, and CMS is telling everyone what a great program it is. If CMS is showing interest in Cramton's mock auction, they're doing so not to support a repeal, but to get ideas for future rounds.
One state association leader calls Cramton's work "too important to ignore."
Huh?
Cramton's work is only "important" in that its premise is that the current program won't work as is. And that's where the "importance" of the work ends. Cramton is not our industry's champion; he's out to prove that his version of bidding is better.
Do you support that? I don't. I want competitive bidding repealed, not retooled. The mock auction is not about making ourselves heard, and it's not about making CMS rethink competitive bidding. Industry providers and industry "leaders" can attend this event and make noise when they don't like something, but that's not going to change the focus of the event and it's not going to give us any advantage.
One "leader" said something about the mock auction being an opportunity to have a "discussion."It's not an industry-designed or industry-hosted event. It's an event that people are expected to pay to attend (at $80.00 per person, which no doubt goes into Mr. Cramton's pocket; it's nice of us to line the pockets of a man who wants to teach CMS to build a stronger program) for the privilege of seeing an economist tell CMS how to continue to make it impossible for us to do business.
A discussion? I won't name the "state leader" who came up with that bit of brilliance (this time). But considering how often the individual in question waffles and sucks up to AAHomecare, I guess I'm not surprised. Disappointed, but not surprised. He should be ashamed.
I think that any right-thinking person should boycott this and focus on telling legislators that we are opposed to the continuation of competitive bidding in any form; even that of Peter Cramton.
And I think that any industry "leader" who supports Cramton should be a leader no more.
Speaking of Leaders ...
AAHomecare is doing what it's always done but has never gotten results from.
I've always defined insanity as doing the same thing over and over again but expecting different results.
AAHomecare has persuaded yet another Representative to introduce what's being called a "budget-neutral" bill that will repeal competitive bidding.
Deja vu!!
How many of the past bills to repeal the program have been successful? I can count them on the toes of one hand.
So those of you who are storming D.C. will be able to ask your Representatives to support the bill. And Tyler Wilson is patting himself on the back, expecting the industry to think that he and AAHomecare are the greatest things since sliced bread.
The last bill, introduced by Meek, got 259 supporters, but never got out of committee and never got a single Senator willing to touch it. AAHomecare is saying that people can now go to legislators and talk about the "real" problems with round one: problems with access, confusion, and extra costs because patients can't be discharged as quickly.
Readers, the program was implemented January 1st. We're now in the middle of March. Did anyone honestly expect that implementation of a program so big would have no hiccups? I read about the "problems" in the industry press and from other industry-sympathetic sources, but I have to ask myself this: Are the number of problems increasing? Are they decreasing?
In the long run, competitive bidding will save the Medicare program and beneficiaries money. Lower reimbursements mean lower co-pays, and so seniors aren't shelling out as much if they don't have co-pay coverage.
I don't see how any bill that repeals competitive bidding can begin to be "budget-neutral," and fully expect that the score the legislation will receive will show that my skepticism is right, unless the intent is to slash reimbursements as the pay-for. I don't know about you, but my rising costs of doing business don't allow me to continue to do business by making less money.
I won't need competitive bidding in my area to put me out of business if the already-low reimbursements are cut even more. That's the harsh reality of DME, and people who have no experience running a DME (I'm talking to you, Tyler Wilson) shouldn't be making promises and deals on my behalf that I'm very sure I can't afford. People who answer to boards ruled by big companies with far deeper pockets than I have just don't have a firm grip on the difficulties of running a small industry business, and I'm not interested in following those types (I'm still talking to you, Tyler Wilson).
Do I want to see competitive bidding repealed? Yes. Do I think that AAHomecare's latest attempt at a bill will succeed? No. AAHomecare has handed the industry failure after failure, and I don't see that they've done anything new that's going to change the association's losing streak. I think they're ineffective, and history bears out my judgment.
Too Many Problems and No Solutions
AAHomecare isn't the answer; Peter Cramton and his "mock auction" isn't the answer. I'm going to try to ignore Tyler Wilson and his "go me" posturing; I recognize a bunch of hot air when I hear it.
I'm absolutely boycotting Cramton's event, because I don't want my presence to be construed as supporting a revised method of bidding that might actually work.
I want to serve my patients and earn an honest living. I know that I have to be involved to get rid of competitive bidding, but I'm not interested in doing the same things over and over again and expecting different results. I don't know what the solution is, but I know what -- and who -- hasn't worked, and I don't think it's unreasonable of me to think what I do.
What troubles me are the people who will believe in yet another bill and who will believe that they're going to "be heard" at Cramton's event, and that things will change as a result.
I don't like being let down, and so I choose to travel the road of realism. I don't put my faith in false prophets.
Monday, February 28, 2011
Old News Is Big News For HomeCare Magazine and TAHCS
I thought TAHCS had done providers in Texas a favor and closed its doors; no one I know has heard a peep out of them since their conference in October. None of my contacts was mourning, unless I count those who missed howling with laughter about the bad grammar, atrocious spelling, and too-often hysterical tone of the TAHCS missives.
I have to confess that they always made me laugh too.
Barry Johnson is quoted in today's HomeCare Monday, talking about the changes in Texas Medicaid's incontinence product quantities as announced on February 11, 2011. He complains that the change was posted with "literally no notice;" it's effective April 1, 2011.
Should HHSC have posted a notice that they were going to post a notice? The posting on February 11 was the notice that a change was coming up. Perhaps the notice could and should have been posted sooner, but it's not as though the change was posted on March 31 with an effective date of the next day.
Johnson goes on to say that "at least one major vendor [manufacturer] has said that meeting the April 1 date isn't possible." Yes, there are some repackaging challenges to meet the new date, but the fact is that, based on everything I've heard and read about supplier and manufacturer meetings that the TCPA and HHSC hosted, many of them suggested reducing the allowed product quantities because most recipients don't use what they get.
This is a common-sense move that most suppliers understand will save the state millions of dollars that they don't and shouldn't have to spend. Sending 300 per month when only 240 (or fewer) are actually used is wasteful, Barry Johnson.
If vendors didn't see this coming, they weren't paying attention. It's obvious that Johnson wasn't either.
Johnson goes on to whine about "no guidance" from HHSC about what would qualify on the LMN for approval of additional supplies." How hard can it be to figure out what a physician would need to say to justify that a patient needs more than 240 diapers and (or) 120 underpads?
Thank you, Barry Johnson, for stating the obvious (and thank you, HomeCare magazine, for giving the man an undeserved platform from which to spew his drivel); no one would have figured out without you that lower monthly allowable could have an impact on some special-needs patients.
That's what the LMN is for. D-U-H.
It's only Monday, but here is the line that I'm giving the Dumbest Quote of the Week award for: "Guess nobody said the state had a heart for less fortunate individuals who cannot go to the Capitol and complain."
Cue the violins!
Anyone who's provided incontinence supplies to patients knows that the majority of the time the maximum monthly allowable isn't used. In some cases, the recipients sell them to others, give what they don't use to family members who don't qualify for entitlement programs, or throw them away. There are those out there who do use them all, but that's generally the exception, not the rule.
Legislators can have the biggest hearts in the world, but there are financial realities that we all have to deal with. States need to cut budgets. There are people out there who are struggling to make ends meet, but who are still considered "too wealthy" to receive assistance from the state. They too are "less fortunate" individuals, but they can't benefit from the programs that they're forced to support.
If the people out there struggling to make ends meet have to accept less than what they're used to in these tough economic times, then so too do the "less fortunate" that Johnson imagines himself champion of.
Johnson says that the reduction is ridiculous. If Texas is trying this reduction in lieu of a competitive bid for the incontinence products, it benefits patients and suppliers alike. I don't know that this is what the state is doing, but it is what many suppliers, manufacturers, and MESA (the association for Texas DMEs) has suggested to the state since the proposed initiative was announced.
I'd rather go down the road of a reduction of monthly allowables than see my business bid out of existence.
If anything is ridiculous here, it's Johnson (which is no surprise).
I did some digging around and found the presentation, mentioned by Johnson in the same article, that HHSC chief Suehs made to several committees. In it, a new bid program for many DME items is very clear; what isn't clear is whether or not the bid will be at provider or manufacturer level.
What is clear is that something called "Rider 61" grants HHSC the power to do what they want with no limitations imposed by the Texas legislature. There is nothing I could find that permitted the agency to dispense with rule-making and standard implementation procedures, but I don't do business in Texas, so there could be something I've missed.
I doubt it, but it is a possibility.
The HomeCare Monday article goes on to say that Johnson says that he "would be testifying" before "the" committee (there are several of them; which one does he mean?) about the "effects of such a change."
Well, he says he'll testify "if they listen."
Johnson will only testify if they invite him. I checked out the pertinent Texas legislature committees, and as far as I can tell, they're only hearing testimony from those invited. Unless Johnson has been invited (I can't imagine who'd do something like that), then he's not testifying anywhere.
That would be a (very) good thing, because I'm very sure that there are people out there who are more credible, reliable, and articulate than Barry Johnson.
I'm sure there are more useful ones too; several of my readers tell me that while MESA gave the state a comprehensive alternative proposal to the incontinence bid, TAHCS did not. Attending meetings and mumbling opinions into a microphone does not count, in my opinion, as effective advocacy, and this is what Johnson and TAHCS has to offer.
It's my opinion that if providers in Texas need Barry Johnson and TAHCS to save them, they're already done for.
I think that Johnson is trying to keep TAHCS alive (or keep the illusion that TAHCS is alive) because he feels more empowered with it than he is as an individual. If he can make legislators and state agencies believe that he has a following through TAHCS, his opinions will matter more as a representative of many than as an individual.
Barry Johnson the individual might not get attention if he sends a press release containing his thoughts to a publication like HomeCare magazine, but if he sends it out as the president of TAHCS, a lazy publication (HomeCare magazine) will accept it (without questioning and fact-checking, apparently). I can only hope that HME News won't take the same downward step.
The problem with Johnson's illusion (delusion?) that he represents a multitude is that it's misleading. TAHCS does not have a following, and Johnson doesn't have a cohesive, intelligent, and organized approach. He is not representative of suppliers in Texas, and playing the "have a heart" card is just plain stupid.
Barry Johnson, please shut up and go away. HomeCare Monday, please develop some journalism standards and stop publishing garbage.
I have to confess that they always made me laugh too.
Barry Johnson is quoted in today's HomeCare Monday, talking about the changes in Texas Medicaid's incontinence product quantities as announced on February 11, 2011. He complains that the change was posted with "literally no notice;" it's effective April 1, 2011.
Should HHSC have posted a notice that they were going to post a notice? The posting on February 11 was the notice that a change was coming up. Perhaps the notice could and should have been posted sooner, but it's not as though the change was posted on March 31 with an effective date of the next day.
Johnson goes on to say that "at least one major vendor [manufacturer] has said that meeting the April 1 date isn't possible." Yes, there are some repackaging challenges to meet the new date, but the fact is that, based on everything I've heard and read about supplier and manufacturer meetings that the TCPA and HHSC hosted, many of them suggested reducing the allowed product quantities because most recipients don't use what they get.
This is a common-sense move that most suppliers understand will save the state millions of dollars that they don't and shouldn't have to spend. Sending 300 per month when only 240 (or fewer) are actually used is wasteful, Barry Johnson.
If vendors didn't see this coming, they weren't paying attention. It's obvious that Johnson wasn't either.
Johnson goes on to whine about "no guidance" from HHSC about what would qualify on the LMN for approval of additional supplies." How hard can it be to figure out what a physician would need to say to justify that a patient needs more than 240 diapers and (or) 120 underpads?
Thank you, Barry Johnson, for stating the obvious (and thank you, HomeCare magazine, for giving the man an undeserved platform from which to spew his drivel); no one would have figured out without you that lower monthly allowable could have an impact on some special-needs patients.
That's what the LMN is for. D-U-H.
It's only Monday, but here is the line that I'm giving the Dumbest Quote of the Week award for: "Guess nobody said the state had a heart for less fortunate individuals who cannot go to the Capitol and complain."
Cue the violins!
Anyone who's provided incontinence supplies to patients knows that the majority of the time the maximum monthly allowable isn't used. In some cases, the recipients sell them to others, give what they don't use to family members who don't qualify for entitlement programs, or throw them away. There are those out there who do use them all, but that's generally the exception, not the rule.
Legislators can have the biggest hearts in the world, but there are financial realities that we all have to deal with. States need to cut budgets. There are people out there who are struggling to make ends meet, but who are still considered "too wealthy" to receive assistance from the state. They too are "less fortunate" individuals, but they can't benefit from the programs that they're forced to support.
If the people out there struggling to make ends meet have to accept less than what they're used to in these tough economic times, then so too do the "less fortunate" that Johnson imagines himself champion of.
Johnson says that the reduction is ridiculous. If Texas is trying this reduction in lieu of a competitive bid for the incontinence products, it benefits patients and suppliers alike. I don't know that this is what the state is doing, but it is what many suppliers, manufacturers, and MESA (the association for Texas DMEs) has suggested to the state since the proposed initiative was announced.
I'd rather go down the road of a reduction of monthly allowables than see my business bid out of existence.
If anything is ridiculous here, it's Johnson (which is no surprise).
I did some digging around and found the presentation, mentioned by Johnson in the same article, that HHSC chief Suehs made to several committees. In it, a new bid program for many DME items is very clear; what isn't clear is whether or not the bid will be at provider or manufacturer level.
What is clear is that something called "Rider 61" grants HHSC the power to do what they want with no limitations imposed by the Texas legislature. There is nothing I could find that permitted the agency to dispense with rule-making and standard implementation procedures, but I don't do business in Texas, so there could be something I've missed.
I doubt it, but it is a possibility.
The HomeCare Monday article goes on to say that Johnson says that he "would be testifying" before "the" committee (there are several of them; which one does he mean?) about the "effects of such a change."
Well, he says he'll testify "if they listen."
Johnson will only testify if they invite him. I checked out the pertinent Texas legislature committees, and as far as I can tell, they're only hearing testimony from those invited. Unless Johnson has been invited (I can't imagine who'd do something like that), then he's not testifying anywhere.
That would be a (very) good thing, because I'm very sure that there are people out there who are more credible, reliable, and articulate than Barry Johnson.
I'm sure there are more useful ones too; several of my readers tell me that while MESA gave the state a comprehensive alternative proposal to the incontinence bid, TAHCS did not. Attending meetings and mumbling opinions into a microphone does not count, in my opinion, as effective advocacy, and this is what Johnson and TAHCS has to offer.
It's my opinion that if providers in Texas need Barry Johnson and TAHCS to save them, they're already done for.
I think that Johnson is trying to keep TAHCS alive (or keep the illusion that TAHCS is alive) because he feels more empowered with it than he is as an individual. If he can make legislators and state agencies believe that he has a following through TAHCS, his opinions will matter more as a representative of many than as an individual.
Barry Johnson the individual might not get attention if he sends a press release containing his thoughts to a publication like HomeCare magazine, but if he sends it out as the president of TAHCS, a lazy publication (HomeCare magazine) will accept it (without questioning and fact-checking, apparently). I can only hope that HME News won't take the same downward step.
The problem with Johnson's illusion (delusion?) that he represents a multitude is that it's misleading. TAHCS does not have a following, and Johnson doesn't have a cohesive, intelligent, and organized approach. He is not representative of suppliers in Texas, and playing the "have a heart" card is just plain stupid.
Barry Johnson, please shut up and go away. HomeCare Monday, please develop some journalism standards and stop publishing garbage.
Thursday, February 17, 2011
Conundrums and Conflicts
I've had some feedback on my last blog. I'm always appreciative of the dialogues that I have with readers; the back-and-forth is invariably productive, thoughtful, and intelligent. My readers and I may not always agree on all points, but communication is the doorway to understanding.
Any fool can criticize, condemn, and complain but it takes character and self control to be understanding and forgiving. (Dale Carnegie)
No, this isn't going to be a feel-good blog; I'm not going "soft" on you.
Tell me and I'll forget; show me and I may remember; involve me and I'll understand. (Chinese Proverb)
There is a great difference between knowing and understanding; you can know a lot about something and not really understand it. (Charles F. Kettering)
Conundrums
I'm using the word "conundrum" as a synonym for "enigma." Here is the definition so you can view the word in context: A conundrum is a paradoxical, insoluble, or difficult problem; a dilemma.
It may well be doubted whether human ingenuity can construct an enigma ... which human ingenuity may not, by proper application, resolve. (Edgar Allan Poe)
It seems to me that when Mr. Poe said that, he wasn't taking government into consideration.
Competitive bidding is this industry's biggest conundrum. I don't think it's a problem that's impossible to solve, but I do think it's going to take greater efforts and better tactics than we've used for the last decade.
I've written a few times that the definition of insanity is doing the same thing over and over again and expecting different results. That definition wasn't lost on one of my readers, who pointed to AAHomecare's new attempt to get a bid-program repeal bill introduced as somewhat insane.
Deja vu!
The latest AAHomecare-inspired bill doesn't stand a chance, and here's why: I'm told by several sources that there is no pay-for in it. If this is true, who's going to touch it?
Bear in mind that I haven't seen the bill, so I can't confirm if what I've been told is correct. But when I have more than one person telling me the exact same thing, I have to move forward on the premise that they're giving me factual information.
The government is working on slashing budgets; our deficit is ridiculous. If what AAHomecare is offering in exchange for repeal doesn't save the program the money it's looking to save, the bill is useless.
As I said in my last blog, AAHomecare has two task forces "working on how to deal with competitive bidding." One task force is "working on a plan to repeal the program and replace it with some other cost-saving measure," and the other is "working on a plan to redesign the existing program to make it more fair."
Task forces are an "action" way to say committee.
A committee is a group of the unprepared, appointed by the unwilling to do the unnecessary. (Fred Allen)
A committee is a group that keeps minutes and loses hours. (Milton Berle)
A committee is an animal with four back legs. (John le Carre)
Here's what I think: AAHomecare has excellent -- and convenient -- timing. It's just amazing how they've timed their "legislative effort" announcement to coincide with their legislative conference. The bill they're supposed to be working on won't be ready for the lobbying they want you to do, but have faith, it'll appear soon.
I don't believe that AAHomecare is serious about repealing competitive bidding. I think that organization's focus is on trying to redesign the program to "make it more fair" (whatever that means). Their noise about a bill is just that: noise. AAHomecare really had no choice; most of the industry is very much against "redesigning" the program, and no doubt the association felt the backlash.
The village idiot would've figured out that that plan would be unpopular before it became public knowledge and would probably have had second thoughts about it before letting it out of the gate.
I think the AAHomecare bill is pointless, and I think AAHomecare knows it. I think this tactic is about damage control, not productivity. I think the bill is about appearances; if the industry thinks that AAHomecare is going to actually fight for repeal, AAHomecare's legislative conference might attract more attendees (which will have a positive impact on what the association makes on the event).
One of my readers told me that "if all who went to D.C. for this no-gain conference [just] wrote a check for [a fraction of] the cost of the trip ... probably $400, and met with them (legislators) [in district offices], we might just make some friends."
I agree. In contributing a few hundred dollars to a legislator, you buy some influence. You'd also save quite a bit of money by approaching the problem with this method than with an expensive lobbying trip to D.C. that will achieve absolutely nothing.
You can go, you can spend time with an aide, and once you've walked out that door, you're forgotten. Yes, the aide took notes, and made appropriate-if-noncommittal noises at you. Yes, you got a certain amount of consideration because you're a constituent (or because you represent a group of constituents). But once the election is over, the legislator's need for you is over until he or she runs for re-election.
If you're a contributor, however, you'll be taken more seriously; after all, if you contribute once, you might do so again, and your checkbook is a good motivator.
Cynical? No. It's how politics works.
It's your money, and you have to decide how important it is to spend it in such a way that you get something out of spending it.
Conflicts
It's occurred to me that people who own or represent DME companies, and who have won contracts in the bid areas, should not sit on the boards of DME associations that are actively fighting to repeal the program.
It's about a conflict of interests and ethics.
I understand that those who participated in the bid process did so to stay in business. I really do get that. But participation implies consent just as effectively as silence does.
It's all well and good to say that you don't want competitive bidding and that you want to see it repealed, but if you came out of the process with a contract (or contracts), you have nothing to lose by playing both sides.
Those who didn't win contracts, however, have almost everything to lose.
Having gone through the bid process and come out a "winner," there is a reason to hope that the program stays in place. Bid winners have a lock on the new beneficiaries who need equipment in the bid categories, and as a result of the program, the competition for those beneficiaries is less than it used to be.
Yes, the reimbursement rates in the bid areas are low, but whose fault is that? The bidders themselves dictated the rates.
This, in my opinion, goes far in explaining the "tweak" strategy of AAHomecare; it serves the interests of the AAHomecare board members who hold contracts. It's a strategy that will benefit the association because it supports those companies most likely to be left standing once the program has been rolled out coast-to-coast.
It raises the specter of a conflict of interest. It's an ethical question. (Roberta Baskin)
I have formed the opinion that I have because AAHomecare's agenda is what it is. I don't think there's any deliberate manipulation or deliberate malice involved; I think it's more about survival of the fittest than anything else.
AAHomecare can try to point to its two task forces that have two different purposes to illustrate that my conclusions are incorrect, but when I'm thinking about this, I take into consideration AAHomecare's consistent failure to get results and the fact that the organization developed its "program redesign" strategy well before it announced a continued fight to repeal (an announcement that was motivated by anger from the industry, I suspect).
There needs to be some reform on some industry association boards. The victors cannot objectively represent or work for the interests of the losers. And when the losers suspect the motives of the winners, the faith in the organization in question is eroded. It doesn't matter if the doubt is justified; what matters is that it exists.
The good news is that AAHomecare doesn't appear to have the influence or the credibility to follow through on any strategy it develops. This is good in one way and dire in another; if our "voice in Washington" isn't taken seriously by legislators and CMS, the industry as a whole won't be either.
We are judged by the company we keep.
Events of Interest Closer to Home
The state and regional associations offer conferences and seminars that are informative and closer to home (less expensive to attend, too). Coming up through March are:
SCMESA Meeting: Columbia, SC, February 24
CAMPS Annual Convention, Irvine, CA, March 1 - 2
VADMEC Winter Conference, Richmond, VA, March 8 - 9
MESA All-Star Conference, Dallas, TX, March 15 - 18
JAMES General Meeting, Monroe, NJ, March 22
MAMES Convention and Expo, Omaha, NE, March 24 - 25
TAHC Spring Conference, Franklin, TN, March 27 - 29
If your state doesn't have an organization, or if your state's association doesn't offer opportunities like the ones above, you might want to look into going to one taking place in a nearby state.
Any fool can criticize, condemn, and complain but it takes character and self control to be understanding and forgiving. (Dale Carnegie)
No, this isn't going to be a feel-good blog; I'm not going "soft" on you.
Tell me and I'll forget; show me and I may remember; involve me and I'll understand. (Chinese Proverb)
There is a great difference between knowing and understanding; you can know a lot about something and not really understand it. (Charles F. Kettering)
Conundrums
I'm using the word "conundrum" as a synonym for "enigma." Here is the definition so you can view the word in context: A conundrum is a paradoxical, insoluble, or difficult problem; a dilemma.
It may well be doubted whether human ingenuity can construct an enigma ... which human ingenuity may not, by proper application, resolve. (Edgar Allan Poe)
It seems to me that when Mr. Poe said that, he wasn't taking government into consideration.
Competitive bidding is this industry's biggest conundrum. I don't think it's a problem that's impossible to solve, but I do think it's going to take greater efforts and better tactics than we've used for the last decade.
I've written a few times that the definition of insanity is doing the same thing over and over again and expecting different results. That definition wasn't lost on one of my readers, who pointed to AAHomecare's new attempt to get a bid-program repeal bill introduced as somewhat insane.
Deja vu!
The latest AAHomecare-inspired bill doesn't stand a chance, and here's why: I'm told by several sources that there is no pay-for in it. If this is true, who's going to touch it?
Bear in mind that I haven't seen the bill, so I can't confirm if what I've been told is correct. But when I have more than one person telling me the exact same thing, I have to move forward on the premise that they're giving me factual information.
The government is working on slashing budgets; our deficit is ridiculous. If what AAHomecare is offering in exchange for repeal doesn't save the program the money it's looking to save, the bill is useless.
As I said in my last blog, AAHomecare has two task forces "working on how to deal with competitive bidding." One task force is "working on a plan to repeal the program and replace it with some other cost-saving measure," and the other is "working on a plan to redesign the existing program to make it more fair."
Task forces are an "action" way to say committee.
A committee is a group of the unprepared, appointed by the unwilling to do the unnecessary. (Fred Allen)
A committee is a group that keeps minutes and loses hours. (Milton Berle)
A committee is an animal with four back legs. (John le Carre)
Here's what I think: AAHomecare has excellent -- and convenient -- timing. It's just amazing how they've timed their "legislative effort" announcement to coincide with their legislative conference. The bill they're supposed to be working on won't be ready for the lobbying they want you to do, but have faith, it'll appear soon.
I don't believe that AAHomecare is serious about repealing competitive bidding. I think that organization's focus is on trying to redesign the program to "make it more fair" (whatever that means). Their noise about a bill is just that: noise. AAHomecare really had no choice; most of the industry is very much against "redesigning" the program, and no doubt the association felt the backlash.
The village idiot would've figured out that that plan would be unpopular before it became public knowledge and would probably have had second thoughts about it before letting it out of the gate.
I think the AAHomecare bill is pointless, and I think AAHomecare knows it. I think this tactic is about damage control, not productivity. I think the bill is about appearances; if the industry thinks that AAHomecare is going to actually fight for repeal, AAHomecare's legislative conference might attract more attendees (which will have a positive impact on what the association makes on the event).
One of my readers told me that "if all who went to D.C. for this no-gain conference [just] wrote a check for [a fraction of] the cost of the trip ... probably $400, and met with them (legislators) [in district offices], we might just make some friends."
I agree. In contributing a few hundred dollars to a legislator, you buy some influence. You'd also save quite a bit of money by approaching the problem with this method than with an expensive lobbying trip to D.C. that will achieve absolutely nothing.
You can go, you can spend time with an aide, and once you've walked out that door, you're forgotten. Yes, the aide took notes, and made appropriate-if-noncommittal noises at you. Yes, you got a certain amount of consideration because you're a constituent (or because you represent a group of constituents). But once the election is over, the legislator's need for you is over until he or she runs for re-election.
If you're a contributor, however, you'll be taken more seriously; after all, if you contribute once, you might do so again, and your checkbook is a good motivator.
Cynical? No. It's how politics works.
It's your money, and you have to decide how important it is to spend it in such a way that you get something out of spending it.
Conflicts
It's occurred to me that people who own or represent DME companies, and who have won contracts in the bid areas, should not sit on the boards of DME associations that are actively fighting to repeal the program.
It's about a conflict of interests and ethics.
I understand that those who participated in the bid process did so to stay in business. I really do get that. But participation implies consent just as effectively as silence does.
It's all well and good to say that you don't want competitive bidding and that you want to see it repealed, but if you came out of the process with a contract (or contracts), you have nothing to lose by playing both sides.
Those who didn't win contracts, however, have almost everything to lose.
Having gone through the bid process and come out a "winner," there is a reason to hope that the program stays in place. Bid winners have a lock on the new beneficiaries who need equipment in the bid categories, and as a result of the program, the competition for those beneficiaries is less than it used to be.
Yes, the reimbursement rates in the bid areas are low, but whose fault is that? The bidders themselves dictated the rates.
This, in my opinion, goes far in explaining the "tweak" strategy of AAHomecare; it serves the interests of the AAHomecare board members who hold contracts. It's a strategy that will benefit the association because it supports those companies most likely to be left standing once the program has been rolled out coast-to-coast.
It raises the specter of a conflict of interest. It's an ethical question. (Roberta Baskin)
I have formed the opinion that I have because AAHomecare's agenda is what it is. I don't think there's any deliberate manipulation or deliberate malice involved; I think it's more about survival of the fittest than anything else.
AAHomecare can try to point to its two task forces that have two different purposes to illustrate that my conclusions are incorrect, but when I'm thinking about this, I take into consideration AAHomecare's consistent failure to get results and the fact that the organization developed its "program redesign" strategy well before it announced a continued fight to repeal (an announcement that was motivated by anger from the industry, I suspect).
There needs to be some reform on some industry association boards. The victors cannot objectively represent or work for the interests of the losers. And when the losers suspect the motives of the winners, the faith in the organization in question is eroded. It doesn't matter if the doubt is justified; what matters is that it exists.
The good news is that AAHomecare doesn't appear to have the influence or the credibility to follow through on any strategy it develops. This is good in one way and dire in another; if our "voice in Washington" isn't taken seriously by legislators and CMS, the industry as a whole won't be either.
We are judged by the company we keep.
Events of Interest Closer to Home
The state and regional associations offer conferences and seminars that are informative and closer to home (less expensive to attend, too). Coming up through March are:
SCMESA Meeting: Columbia, SC, February 24
CAMPS Annual Convention, Irvine, CA, March 1 - 2
VADMEC Winter Conference, Richmond, VA, March 8 - 9
MESA All-Star Conference, Dallas, TX, March 15 - 18
JAMES General Meeting, Monroe, NJ, March 22
MAMES Convention and Expo, Omaha, NE, March 24 - 25
TAHC Spring Conference, Franklin, TN, March 27 - 29
If your state doesn't have an organization, or if your state's association doesn't offer opportunities like the ones above, you might want to look into going to one taking place in a nearby state.
Monday, February 14, 2011
Next Up: Round Two
Like everyone else in the industry, I've been waiting for details about round two of competitive bidding. It's inevitable; sort of like death and taxes, but worse, because it's a slow and very painful process that seems to have no end.
It should come as no surprise to anyone that CMS is working on round two.
There may be additions to items in the bid, but I, like most, don't expect huge changes to the program. Why change what's billed as a good thing?
I think that there's going to have to be more prep work because so many MSAs are involved, and this may explain why we're not hearing much out of CMS about the bid.
HME News did an article about this topic last week, and the publication said that stakeholders are hoping that CMS is taking its time "to improve its outreach efforts to referral sources and beneficiaries."
I'm going to run against the herd and say that I didn't think that CMS did such a bad job notifying beneficiaries in the round-one MSAs.
I'll pause while you recover from the shock of what I just said.
My parents are Medicare beneficiaries, and they received literature from CMS that was very clear, in a basic kind of way, about competitive bidding and how it would have an impact on their Part B benefits. Though it didn't have paragraph after paragraph of detail, it did give an overview of competitive bidding for DME, and what equipment was included.
CMS may be stretching the truth when it claims that the program is a wonderful thing, but there are good aspects to it from the consumer and tax-payer point of view. With the reduced reimbursements, beneficiaries do save money on co-pays.
Peter Amico is quoted in the article talking about "all the problems with round one with doctors and patients being confused and misled," but based on everything I've read (and I've gone looking for news about it), there wasn't as much confusion and there weren't as many problems as the industry had hoped for.
Saying that doctors and patients were "misled" is a bit strong. There was definitely some misunderstanding, and perhaps CMS could have given better information. But the avalanche of problems and complaints that we needed simply didn't materialize.
This is a problem.
AAHomecare has task forces -- two of them -- "working on how to deal with competitive bidding." One task force is "working on a plan to repeal the program and replace it with some other cost-saving measure," and the other is "working on a plan to redesign the existing program to make it more fair."
We've had more than a decade to come up with the former, and the latter is, I firmly believe, AAHomecare's goal because they know they are incapable of getting rid of the competitive bid.
It's the easier of the two goals, but I'm going to say now that I don't think AAHomecare has the credibility to accomplish either one.
They have an upcoming legislative conference, but they have no bill to promote and no strategy. Yet they want us to come to D.C. and talk to legislators about competitive bidding and the fact that we don't want it.
You can attend their event and engage in no-point lobbying for the bargain-basement price of $245 for members and $355 for nonmembers!
Now add to your registration fee the cost of transportation to get there, and a hotel room for a stupid amount of money per night, plus meals and incidentals, and you've spent a tidy sum of money to attend an event that has no strategy, no talking points (other than the fact that competitive bidding is bad), and no cohesive goal.
AAHomecare wants us to come to D.C. and tell lawmakers that the program is "flawed," but what documentation can they offer to substantiate the claims they want us to make? We've been telling lawmakers for more than three years that the program is "flawed," and has that gotten us anywhere?
No.
This is a tired event, and it's a lot of money for someone to spend when there are no results (and never have been results). If I'm going to spend my money on something, I expect to get something in return.
I can (and do) lobby my representative and senators in my district. I don't have buckets of cash to spend on an event that's held every year and that produces no results.
And I'm not going to pay an outrageous registration fee to AAHomecare; lining the pockets of an organization that's failed the industry for more than a decade is not, in my opinion, a sound investment.
Especially when AAHomecare is employing the same, worn-out arguments against the bid. They're trying the same thing over and over again, and expecting different results.
That's not only insane, it's misleading. AAHomecare says it's no time to pull back? They may be right, but considering how little good they've done the industry, it's also no time to help fund an event and an organization that doesn't work.
Think about it.
It should come as no surprise to anyone that CMS is working on round two.
There may be additions to items in the bid, but I, like most, don't expect huge changes to the program. Why change what's billed as a good thing?
I think that there's going to have to be more prep work because so many MSAs are involved, and this may explain why we're not hearing much out of CMS about the bid.
HME News did an article about this topic last week, and the publication said that stakeholders are hoping that CMS is taking its time "to improve its outreach efforts to referral sources and beneficiaries."
I'm going to run against the herd and say that I didn't think that CMS did such a bad job notifying beneficiaries in the round-one MSAs.
I'll pause while you recover from the shock of what I just said.
My parents are Medicare beneficiaries, and they received literature from CMS that was very clear, in a basic kind of way, about competitive bidding and how it would have an impact on their Part B benefits. Though it didn't have paragraph after paragraph of detail, it did give an overview of competitive bidding for DME, and what equipment was included.
CMS may be stretching the truth when it claims that the program is a wonderful thing, but there are good aspects to it from the consumer and tax-payer point of view. With the reduced reimbursements, beneficiaries do save money on co-pays.
Peter Amico is quoted in the article talking about "all the problems with round one with doctors and patients being confused and misled," but based on everything I've read (and I've gone looking for news about it), there wasn't as much confusion and there weren't as many problems as the industry had hoped for.
Saying that doctors and patients were "misled" is a bit strong. There was definitely some misunderstanding, and perhaps CMS could have given better information. But the avalanche of problems and complaints that we needed simply didn't materialize.
This is a problem.
AAHomecare has task forces -- two of them -- "working on how to deal with competitive bidding." One task force is "working on a plan to repeal the program and replace it with some other cost-saving measure," and the other is "working on a plan to redesign the existing program to make it more fair."
We've had more than a decade to come up with the former, and the latter is, I firmly believe, AAHomecare's goal because they know they are incapable of getting rid of the competitive bid.
It's the easier of the two goals, but I'm going to say now that I don't think AAHomecare has the credibility to accomplish either one.
They have an upcoming legislative conference, but they have no bill to promote and no strategy. Yet they want us to come to D.C. and talk to legislators about competitive bidding and the fact that we don't want it.
You can attend their event and engage in no-point lobbying for the bargain-basement price of $245 for members and $355 for nonmembers!
Now add to your registration fee the cost of transportation to get there, and a hotel room for a stupid amount of money per night, plus meals and incidentals, and you've spent a tidy sum of money to attend an event that has no strategy, no talking points (other than the fact that competitive bidding is bad), and no cohesive goal.
AAHomecare wants us to come to D.C. and tell lawmakers that the program is "flawed," but what documentation can they offer to substantiate the claims they want us to make? We've been telling lawmakers for more than three years that the program is "flawed," and has that gotten us anywhere?
No.
This is a tired event, and it's a lot of money for someone to spend when there are no results (and never have been results). If I'm going to spend my money on something, I expect to get something in return.
I can (and do) lobby my representative and senators in my district. I don't have buckets of cash to spend on an event that's held every year and that produces no results.
And I'm not going to pay an outrageous registration fee to AAHomecare; lining the pockets of an organization that's failed the industry for more than a decade is not, in my opinion, a sound investment.
Especially when AAHomecare is employing the same, worn-out arguments against the bid. They're trying the same thing over and over again, and expecting different results.
That's not only insane, it's misleading. AAHomecare says it's no time to pull back? They may be right, but considering how little good they've done the industry, it's also no time to help fund an event and an organization that doesn't work.
Think about it.
Thursday, February 3, 2011
A Sensitive Debate
So far all of my blogs have been about DME. It's an important topic because the industry's role in healthcare has been under-valued and misrepresented (to a degree).
But today I'm going to discuss something else entirely.
A Norwegian politician has nominated WikiLeaks for a Nobel Peace Prize; the reason for doing so is because the site has contributed to "democracy and freedom of speech" worldwide.
I have mixed feelings about WikiLeaks and Julian Assange.
There have been many blogs about WikiLeaks, and those defending the organization (and Assange) fall back on our "freedom of speech." Before I launch into the meat of this blog, I want to examine our freedom of speech. Here's the text of the oft-cited first amendment:
Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the government for a redress of grievances.
I've never understood how burning the flag can be permitted by the first amendment; burning a flag is neither speech, nor is it a peaceable assembly. Burning flags may be a method of expression, but I'm not sure that I agree that the amendment should be interpreted the way it has.
Am I a lawyer? Of course not. But my own opinion is that lawyers are part of what's wrong with this country, and one doesn't (or shouldn't) need a lawyer to interpret a document that's relatively easy to understand. Once a lawyer puts his or her "spin" on things, we run into issues. Lawyers tend to interpret things in ways that best serve them. That's a generalization (I'm sure there are some honest lawyers out there), but I think it's one with which many will agree.
Our founding fathers did the best they could at the time this country was founded. They could not have foreseen where technology would take us, or that in a short two hundred (or so) years, Americans would be more interested in their "rights" than in their responsibilities.
If one looks at the culture at the writing of the Constitution, the intents of the authors become clear. Certain tweaks were definitely in order (allowing women to vote, etc., was an obviously needed change), but on the whole, it's a solid document.
A lot of people, when discussing WikiLeaks and Julian Assange, throw our "freedom of speech" concept around; some people use it for WikiLeaks, and some use it against. Most foreigner posters use it like a club on Americans, even though it's clear from their posts that they don't understand us or our laws (I'm always amused when someone who's never been here tells us what's wrong with us).
Americans are a contradictory group, and we never seem to be able to agree on much. The last time the majority of this country agreed on something, we were wrong (in a huge way).
Don't believe me? Search your memories for how most Americans were gung-ho about W leading us into Iraq because of WMDs and links to al quaida; you'll do well to remember how Americans who publicly disagreed were villified and accused of being traitors.
Those "traitors" were right though. There were no WMDs, there were no links to bin Laden, and Iraq was no threat to our national security. We were lied to. We know that now, but the consequences of those lies have helped to shape the world view of our country and the people in it. And though the U.S. hasn't always been popular everywhere, our Bush-era belligerence and aggression turned many in the world against us.
As I said, I have mixed feelings about WikiLeaks and Julian Assange. I can argue for and against them. I know people who feel strongly about the topic, and who see WikiLeaks and Julian Assange only one way.
So I'm going to state the case for both sides.
For Them
WikiLeaks isn't a terrorist organization.
The organization's stated goal is to ensure transparency and accountability of governments and other institutions (banks, for example).
There is a lot that we don't know; there's a lot of information that our government deliberately hides from us. And though there are defense secrets that shouldn't be published or broadcast, there is information that's kept from us that has nothing to do with defense or security.
Yes, even in the United States. Don't believe me? Try to do a public records request, and see how much information is redacted or, worse yet, how often a government agency will seek to evade releasing information that might do the agency harm (largely because of their own internal waste and incompentence).
Every time a government agency -- take CMS for example -- withholds information, it's evading scrutiny. I've submitted records requests to CMS on several occasions, but gotten very little in return. There are an astounding number of "exemptions" that allow an agency like CMS to keep information from you.
Yes, even though you're a tax-payer and citizen, and should have the right to know what your government is doing.
It's unfortunate that lawmakers have built in so many exemptions and appeals for agencies to attorneys general that you can be told "no," and have no recourse at all (except through expensive litigation, which most of us can't afford, and the government knows this).
There is a mass delusion that because a citizen can do a public records request, that there is transparency in government; all you have to do is ask (and sometimes pay) for the information.
WikiLeaks has exposed corruption, torture, war crimes, and duplicity. WikiLeaks has exposed hypocrisy, censorship, and deception. Though those things aren't what we associate with our government, we should, because they exist.
WikiLeaks says that it improves transparency, which in turn leads to reduced corruption. I agree that transparency reduces corruption and improves accountability. I think that every single government agency and government employee should be held to a very high standard and should be prepared to be investigated and answerable for what's done. Government exists on the backs of the people who pay taxes, and the people who pay taxes have a right to know what's going on.
It's unfortunate that the opposite is true. Don't believe me? Let's look at Charles Rangel, the U.S. Representative who was recently censured by the House. This is a man who, for 17 years, deliberately failed to pay taxes on a property he owned, and who withheld documenting assets (among several other things). Was he prosecuted? No. Was he kicked out of the House? No. He had to submit to a public rebuke (and whined about how unfair it was).
If the average citizen had done what Rangel did, we'd be facing prosecution.
The standards for people like Rangel are different from the ones imposed on the rest of us; the legislators protected their own. There was no appropriate accountability in Rangel's censure, nor was the man held to high standards. I call that corruption.
It's corruption on a relatively smalll scale, but if it's so blatant there, then corruption is everywhere. No, I'm not one of those conspiracy theorists. But I do firmly believe that our government hides much from us and lies to us on a regular basis.
Exposing that is a good thing; it might make the people who are supposed to be working for us hesitate the next time they do something that really isn't in our interests if only because they don't want the embarrassment that public exposure will bring.
For a too-brief-yet-glorious moment, we had our legislators nervous during the election season. We were angry, and we sent a message that we were tired of the games they play. The problem is that elections are over, they're still playing the same games, and we're not doing anything about it. The problem is that we're all fundamentally lazy, and we have short attention spans.
We're angry for a moment, and then things return to normal. We accept that our legislators play partisan politics; we ignore the fact that they waste most of our tax dollars. We avoid acknowledging that they lie to us and hide things from us in the name of national security (even when what they're doing has nothing to do with national security). We accept crappy service from civil servants (I'm talking to you, USPS); in short, we settle for what our employees are willing to give.
We imagine that we're informed because we watch the news every night, but blissfully ignore the fact that our journalists slant their stories to match their agendas, the owners of their media outlets, and the expectations of their advertisers.
Enter WikiLeaks. They have no advertisers, and they put no spin on what they publish because the supporting documents are there for all to see.
Governments, search engines, and some carriers have tried to block access to WikiLeaks. I don't know about you, but I'm not interested in having my government or my carrier decide what I can and can't see; I equate censorship with tyranny. If this country guarantees in its Constitution free speech and freedom of the press, then what WikiLeaks is doing is not illegal (and so our government should stop looking for ways to successfully prosecute Assange, assuming they can get their hands on him).
For those who say that Assange is a traitor, I remind you that he's not a citizen of this country, and so owes the U.S. no allegiance (or discretion). And don't bother telling me that if he's not a citizen that our free speech/free press laws don't apply to him; the fact is that we can't preach those freedoms and encourage other countries to adopt our freedoms, and then try to deny them to others when it suits us. We either believe in those freedoms or we don't. We can't have it both ways.
We deserve the truth. That we don't get it from our government is an incredibly sad thing (and it's something we should correct). If WikiLeaks and its supporters are willing to take the heat and the risks to try to ensure transparency and accountability through exposure, we should thank them even as we ask ourselves why getting the truth out there has to come with risks (and persecution).
Against Them
WikiLeaks is a terrorist organization.
They get secret information via secret means, and then ambush their targets without warning.
Some of the information they make public has the potential to put lives at risk; I give you the American military information they've posted, and I give you the current protests in the middle east as examples of the violence that exposure can cause.
Hiding behind a self-righteous and self-serving mission, they take it upon themselves to publish what they get with little thought to the inevitable consequences associated to what they post. They employ no discretion and appear to have damned little regard for the human lives thrust into the turmoil that WikiLeaks creates.
This apparent disregard exposes very little humanity; an argument can be made that WikiLeaks and Assange enjoy the reactions of the organizations they ambush, and that they enjoy having the power to cause them.
There are people involved here, and while the "great" might get singed, it's the "little people" who will pay the greatest price.
WikiLeaks is a group of shadowy people who are taking it upon themselves to make public things that that, in the end, might do more harm than good. There are reasons why things are kept secret (and sometimes those reasons are good).
WikiLeaks is creating situations in which innocent people are getting hurt, and I've seen no sign that Julian Assange takes the human aspect into any consideration; this is a moral and ethical hole in a man who claims to only do good for society. Assange doesn't seem to understand that society is made up of individuals, and that he and WikiLeaks don't (or shouldn't) have the right to do them harm (even if the harm is inadvertent).
Perhaps the WikiLeaks philosphy is that a little chaos now is a small price to pay for a better, more transparent future, but is that the organization's call? No. If WikiLeaks is so committed to accountability, it needs to stop and consider its own.
You Decide
I'll go back to posting on DME-related topics in my next blog. But in the meantime, WikiLeaks and Assange are food for thought.
But today I'm going to discuss something else entirely.
A Norwegian politician has nominated WikiLeaks for a Nobel Peace Prize; the reason for doing so is because the site has contributed to "democracy and freedom of speech" worldwide.
I have mixed feelings about WikiLeaks and Julian Assange.
There have been many blogs about WikiLeaks, and those defending the organization (and Assange) fall back on our "freedom of speech." Before I launch into the meat of this blog, I want to examine our freedom of speech. Here's the text of the oft-cited first amendment:
Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the government for a redress of grievances.
I've never understood how burning the flag can be permitted by the first amendment; burning a flag is neither speech, nor is it a peaceable assembly. Burning flags may be a method of expression, but I'm not sure that I agree that the amendment should be interpreted the way it has.
Am I a lawyer? Of course not. But my own opinion is that lawyers are part of what's wrong with this country, and one doesn't (or shouldn't) need a lawyer to interpret a document that's relatively easy to understand. Once a lawyer puts his or her "spin" on things, we run into issues. Lawyers tend to interpret things in ways that best serve them. That's a generalization (I'm sure there are some honest lawyers out there), but I think it's one with which many will agree.
Our founding fathers did the best they could at the time this country was founded. They could not have foreseen where technology would take us, or that in a short two hundred (or so) years, Americans would be more interested in their "rights" than in their responsibilities.
If one looks at the culture at the writing of the Constitution, the intents of the authors become clear. Certain tweaks were definitely in order (allowing women to vote, etc., was an obviously needed change), but on the whole, it's a solid document.
A lot of people, when discussing WikiLeaks and Julian Assange, throw our "freedom of speech" concept around; some people use it for WikiLeaks, and some use it against. Most foreigner posters use it like a club on Americans, even though it's clear from their posts that they don't understand us or our laws (I'm always amused when someone who's never been here tells us what's wrong with us).
Americans are a contradictory group, and we never seem to be able to agree on much. The last time the majority of this country agreed on something, we were wrong (in a huge way).
Don't believe me? Search your memories for how most Americans were gung-ho about W leading us into Iraq because of WMDs and links to al quaida; you'll do well to remember how Americans who publicly disagreed were villified and accused of being traitors.
Those "traitors" were right though. There were no WMDs, there were no links to bin Laden, and Iraq was no threat to our national security. We were lied to. We know that now, but the consequences of those lies have helped to shape the world view of our country and the people in it. And though the U.S. hasn't always been popular everywhere, our Bush-era belligerence and aggression turned many in the world against us.
As I said, I have mixed feelings about WikiLeaks and Julian Assange. I can argue for and against them. I know people who feel strongly about the topic, and who see WikiLeaks and Julian Assange only one way.
So I'm going to state the case for both sides.
For Them
WikiLeaks isn't a terrorist organization.
The organization's stated goal is to ensure transparency and accountability of governments and other institutions (banks, for example).
There is a lot that we don't know; there's a lot of information that our government deliberately hides from us. And though there are defense secrets that shouldn't be published or broadcast, there is information that's kept from us that has nothing to do with defense or security.
Yes, even in the United States. Don't believe me? Try to do a public records request, and see how much information is redacted or, worse yet, how often a government agency will seek to evade releasing information that might do the agency harm (largely because of their own internal waste and incompentence).
Every time a government agency -- take CMS for example -- withholds information, it's evading scrutiny. I've submitted records requests to CMS on several occasions, but gotten very little in return. There are an astounding number of "exemptions" that allow an agency like CMS to keep information from you.
Yes, even though you're a tax-payer and citizen, and should have the right to know what your government is doing.
It's unfortunate that lawmakers have built in so many exemptions and appeals for agencies to attorneys general that you can be told "no," and have no recourse at all (except through expensive litigation, which most of us can't afford, and the government knows this).
There is a mass delusion that because a citizen can do a public records request, that there is transparency in government; all you have to do is ask (and sometimes pay) for the information.
WikiLeaks has exposed corruption, torture, war crimes, and duplicity. WikiLeaks has exposed hypocrisy, censorship, and deception. Though those things aren't what we associate with our government, we should, because they exist.
WikiLeaks says that it improves transparency, which in turn leads to reduced corruption. I agree that transparency reduces corruption and improves accountability. I think that every single government agency and government employee should be held to a very high standard and should be prepared to be investigated and answerable for what's done. Government exists on the backs of the people who pay taxes, and the people who pay taxes have a right to know what's going on.
It's unfortunate that the opposite is true. Don't believe me? Let's look at Charles Rangel, the U.S. Representative who was recently censured by the House. This is a man who, for 17 years, deliberately failed to pay taxes on a property he owned, and who withheld documenting assets (among several other things). Was he prosecuted? No. Was he kicked out of the House? No. He had to submit to a public rebuke (and whined about how unfair it was).
If the average citizen had done what Rangel did, we'd be facing prosecution.
The standards for people like Rangel are different from the ones imposed on the rest of us; the legislators protected their own. There was no appropriate accountability in Rangel's censure, nor was the man held to high standards. I call that corruption.
It's corruption on a relatively smalll scale, but if it's so blatant there, then corruption is everywhere. No, I'm not one of those conspiracy theorists. But I do firmly believe that our government hides much from us and lies to us on a regular basis.
Exposing that is a good thing; it might make the people who are supposed to be working for us hesitate the next time they do something that really isn't in our interests if only because they don't want the embarrassment that public exposure will bring.
For a too-brief-yet-glorious moment, we had our legislators nervous during the election season. We were angry, and we sent a message that we were tired of the games they play. The problem is that elections are over, they're still playing the same games, and we're not doing anything about it. The problem is that we're all fundamentally lazy, and we have short attention spans.
We're angry for a moment, and then things return to normal. We accept that our legislators play partisan politics; we ignore the fact that they waste most of our tax dollars. We avoid acknowledging that they lie to us and hide things from us in the name of national security (even when what they're doing has nothing to do with national security). We accept crappy service from civil servants (I'm talking to you, USPS); in short, we settle for what our employees are willing to give.
We imagine that we're informed because we watch the news every night, but blissfully ignore the fact that our journalists slant their stories to match their agendas, the owners of their media outlets, and the expectations of their advertisers.
Enter WikiLeaks. They have no advertisers, and they put no spin on what they publish because the supporting documents are there for all to see.
Governments, search engines, and some carriers have tried to block access to WikiLeaks. I don't know about you, but I'm not interested in having my government or my carrier decide what I can and can't see; I equate censorship with tyranny. If this country guarantees in its Constitution free speech and freedom of the press, then what WikiLeaks is doing is not illegal (and so our government should stop looking for ways to successfully prosecute Assange, assuming they can get their hands on him).
For those who say that Assange is a traitor, I remind you that he's not a citizen of this country, and so owes the U.S. no allegiance (or discretion). And don't bother telling me that if he's not a citizen that our free speech/free press laws don't apply to him; the fact is that we can't preach those freedoms and encourage other countries to adopt our freedoms, and then try to deny them to others when it suits us. We either believe in those freedoms or we don't. We can't have it both ways.
We deserve the truth. That we don't get it from our government is an incredibly sad thing (and it's something we should correct). If WikiLeaks and its supporters are willing to take the heat and the risks to try to ensure transparency and accountability through exposure, we should thank them even as we ask ourselves why getting the truth out there has to come with risks (and persecution).
Against Them
WikiLeaks is a terrorist organization.
They get secret information via secret means, and then ambush their targets without warning.
Some of the information they make public has the potential to put lives at risk; I give you the American military information they've posted, and I give you the current protests in the middle east as examples of the violence that exposure can cause.
Hiding behind a self-righteous and self-serving mission, they take it upon themselves to publish what they get with little thought to the inevitable consequences associated to what they post. They employ no discretion and appear to have damned little regard for the human lives thrust into the turmoil that WikiLeaks creates.
This apparent disregard exposes very little humanity; an argument can be made that WikiLeaks and Assange enjoy the reactions of the organizations they ambush, and that they enjoy having the power to cause them.
There are people involved here, and while the "great" might get singed, it's the "little people" who will pay the greatest price.
WikiLeaks is a group of shadowy people who are taking it upon themselves to make public things that that, in the end, might do more harm than good. There are reasons why things are kept secret (and sometimes those reasons are good).
WikiLeaks is creating situations in which innocent people are getting hurt, and I've seen no sign that Julian Assange takes the human aspect into any consideration; this is a moral and ethical hole in a man who claims to only do good for society. Assange doesn't seem to understand that society is made up of individuals, and that he and WikiLeaks don't (or shouldn't) have the right to do them harm (even if the harm is inadvertent).
Perhaps the WikiLeaks philosphy is that a little chaos now is a small price to pay for a better, more transparent future, but is that the organization's call? No. If WikiLeaks is so committed to accountability, it needs to stop and consider its own.
You Decide
I'll go back to posting on DME-related topics in my next blog. But in the meantime, WikiLeaks and Assange are food for thought.
Thursday, January 27, 2011
Partnerships, Professionals, and Parasites
Partnerships
One of my readers forwarded an announcement to me about NAIMES and Brightree forming a "strategic alliance" (whatever that is) that will "help providers stay informed about industry legislation and help promote advocacy efforts to better the DME community."
One of my readers forwarded an announcement to me about NAIMES and Brightree forming a "strategic alliance" (whatever that is) that will "help providers stay informed about industry legislation and help promote advocacy efforts to better the DME community."
The announcement goes on to say: "Under the partnership, Brightree and NAIMES will work together to develop a series of informational programs to help Brightree’s customer base stay informed about various topics, such as competitive bidding, that have a significant impact on the industry."
I'm all for offering new services to customers, but if these "informational programs" have fees associated with them, and if these "informational programs" are offered to providers who aren't clients of Brightree, then I see the potential for conflict.
The state and regional associations already offer informational programs to help all DMEs stay informed about various topics that have a significant impact on the industry. They work hard to do that. I see partnerships like the Brightree/NAIMES one as potentially undermining the associations and draining off resources that these organizations need. Brightree and NAIMES should be working together to encourage Brightree's customers to join the state and regional associations. Investing in them (most of them) is investing in the industry.
I've complained before about businesses and "service organizations" offering their "informational programs" to all who are willing to pay. Even if the Brightree program is free to its customers, the fact is that the advocacy efforts of the state and regional organizations cost money, and implementing programs that compete with them (directly or indirectly) is, in my mind, a bad move.
I'm probably not going to be a member, either, if this is all an organization has to offer.
A good association keeps its members informed. Most do that. They wade through the masses of information they get from multiple sources, sort the needed info from the useless, and send the good nuggets to members.
A good association offers seminars (live, web, and tele) that inform, educate, and are useful to the attendees. I'm not against sales seminars, mind you, but I don't want or need them on a steady basis. Are sales important? Yes. I need a good sales person (or people) to court referral sources. But do I need (or want) sales-related content every month? No.
What I want -- what I need -- is an organization that tells me what's going on with Medicare and what's going on in my state. I need an association that tells me when it's time to be legislatively active (and what to say while I'm being legislatively active). I need an organization that can answer my questions and help me when I need it (or point me in the direction of a person who can help me if my association can't). I need an association that's going to produce events that I can attend for timely information, instruction, and the opportunity talk face-to-face with my peers.
I want a lot, it seems. But many of the state and regional associations that serve the DME industry do all that and more, even though they're under-funded, under-staffed, and under-appreciated.
In most cases, I'm going to trust that the professional running the association I belong to knows what he or she is doing, and is qualified to select good speakers to talk about topics that will have an impact on my business.
I had one person tell me that he didn't belong to the industry association serving his area. He wasn't a non-member because he couldn't afford it, and he didn't choose to not join because the association wasn't a good one. He didn't join because he benefited from the organization's activities without having to pay. They were doing what they were doing without his money anyhow, right? Why pay for what you're going to get free?
My response was to point out that the associations could do more if they had more support (more members means more dues revenue, which means more money to fund efforts). Associations make up for absent dues revenue by producing educational events. Associations support the industry as a whole, not just their clients, and they need "strategic alliances."
I don't often frown at NAIMES, but in this particular case, I must. Though it's nice that Brightree is working on informational programs for its client base, NAIMES would do well to assist the state and regional associations as strongly and as publicly; no one does industry advocacy better or more diligently than they do (in exchange for very little praise and even less recognition).
Professionals vs. Parasites
There are a few cases where industry associations are not run by professionals. Though these few might fancy themselves as qualified to run an industry association because they used to be in the industry or served on the association's board, the fact is that those individuals are rarely successful, which in turn has a negative impact on the organization itself.
Worse yet are associations run by "consultants."
Consultants are people who borrow your watch and tell you what time it is, and then walk off with the watch. (Robert Townsend)
Some consultants are like the bottom half of a double boiler: They get all heated up but don't know what's cooking. (Anonymous)
A consultant is someone who saves his client almost enough to pay his fee. (Anonymous)
Before any consultants reading my blog go postal on me, let me state for the record that there are some good consultants out there. The good ones come in and accomplish what they said they would (which sometimes means that the good consultant must have super-human powers because we can make some big messes of our businesses).
I was at an event and overheard someone grousing about his association and the person running it. He needed some help with a specific issue, and had turned to his association for similar help in the past, so he went to them again. The problem was, he said, that the association was now run by someone else, who seemed more interested in getting him to pay consulting fees than offering him the help he'd always had from his association in the past.
An association should not be a tool used to get clients for the consultant running it; that's parasitical.
If I need a consultant, I'll hire one after careful research of qualifications and experience. But if I'm a member of an association, I've paid for member services, and I'm going to look to the organization for a certain amount of assistance when I need it. Maybe the answer in the scenario I overheard is for the organization to spell out exactly what services a member is entitled to expect, which would avoid misunderstanding.
Or maybe the answer is to have professional staff, which will head off perceived conflicts of interest.
I'm a firm believer in supporting useful associations. I support them by paying dues and by attending the educational sessions they offer because in doing so I contribute to their survival, which in turn helps my business. The relationship between small business and the association to which that small business belongs is symbiotic.
There are several industry conferences coming up in the next few months. Take a look at what your state or regional association is offering and attend, even if you're not a member. Those events offer a more intimate experience than, say, a Medtrade, and in most cases, the sessions presented are tailored to your environment.
We go forward into an uncertain future, but we don't have to go forward alone or uninformed. Form a partnership with your association today.
Thursday, January 20, 2011
Blessed Blessed Silence
I love peace and quiet, and am never uncomfortable in silence, because I always appreciate it.
I've had a couple of readers ask me if I've noticed that TAHCS has gone silent, and I can honestly respond that no, I didn't notice. Sometimes the absence of something, no matter how annoying and dim-witted that something may be, doesn't register, no matter how welcome that absence is.
And the absence of the self-serving, pompous, sub-literate, and too-often-false babble that TAHCS inflicted on the DME world is a welcome one.
Silence is the best answer for and from the stupid. (Stating the Case Blogger)
TAHCS has always touted itself as being the "pro-active" association for DMEs in Texas. They threw the "United we stand" slogan around alot too.
I always thought that the most "pro-active" thing that TAHCS could do was to disappear.
Yes, I'm told that Barry Johnson got up and spoke at a couple of Texas Medicaid meetings (the ones about that state's incontinence bid), but did TAHCS submit any alternative proposals? Nope. I've seen the one that MESA submitted, and it's extremely good. If that bid goes forward in Texas, it won't be for lack of effort on MESA's part to stop it.
It should come as no surprise to anyone that TAHCS can't say the same about its "pro-active" efforts on behalf of Texas DME providers.
The TAHCS guys have exhibited no sense of discretion; that lack goes along well with their extremely economical use of truth, their apparent deficiency in knowledge of the English language, and their utter lack of professionalism (Barry Johnson and Dean Cheney showing up at some MESA events are some great examples of no professionalism).
TAHCS was like a half-assed firecracker. It just fizzled out real quick and made a loud noise. (An edited quote borrowed by the Stating the Case Blogger from Jersey Shore's "The Situation")
Signs point to TAHCS being no more, and that's a step in the right direction for the industry.
AMEPA, it's your turn.
I've had a couple of readers ask me if I've noticed that TAHCS has gone silent, and I can honestly respond that no, I didn't notice. Sometimes the absence of something, no matter how annoying and dim-witted that something may be, doesn't register, no matter how welcome that absence is.
And the absence of the self-serving, pompous, sub-literate, and too-often-false babble that TAHCS inflicted on the DME world is a welcome one.
Silence is the best answer for and from the stupid. (Stating the Case Blogger)
TAHCS has always touted itself as being the "pro-active" association for DMEs in Texas. They threw the "United we stand" slogan around alot too.
I always thought that the most "pro-active" thing that TAHCS could do was to disappear.
Yes, I'm told that Barry Johnson got up and spoke at a couple of Texas Medicaid meetings (the ones about that state's incontinence bid), but did TAHCS submit any alternative proposals? Nope. I've seen the one that MESA submitted, and it's extremely good. If that bid goes forward in Texas, it won't be for lack of effort on MESA's part to stop it.
It should come as no surprise to anyone that TAHCS can't say the same about its "pro-active" efforts on behalf of Texas DME providers.
The TAHCS guys have exhibited no sense of discretion; that lack goes along well with their extremely economical use of truth, their apparent deficiency in knowledge of the English language, and their utter lack of professionalism (Barry Johnson and Dean Cheney showing up at some MESA events are some great examples of no professionalism).
TAHCS was like a half-assed firecracker. It just fizzled out real quick and made a loud noise. (An edited quote borrowed by the Stating the Case Blogger from Jersey Shore's "The Situation")
Signs point to TAHCS being no more, and that's a step in the right direction for the industry.
AMEPA, it's your turn.
Thursday, January 13, 2011
DME Should Be Like Bowling
We the people, in order to form a more perfect UNION ... (Preamble to the United States Constitution)
I correspond with some of my readers on a regular basis; I talk with some more than others. In one recent exchange, I said that I had some radical thoughts on tactics for the industry, and the person with whom I was talking said this:
"I think the industry should go in another direction as well and I'd love to hear your radical thoughts. You never know, someone might listen and get other people to listen. The certain fact is that we're dead if something doesn't change and soon. AAHomecare does not have a clue what to do except [continue] to talk to bureaucrats."
Most people are conditioned to think of something radical as being a bad thing. So let's take a look at the word "radical."
rad·i·cal
adj \ˈra-di-kəl\
1: of, relating to, or proceeding from a root: as
a (1) : of or growing from the root of a plant (radical tubers) (2) : growing from the base of a stem, from a rootlike stem, or from a stem that does not rise above the ground (radical leaves)
b : of, relating to, or constituting a linguistic root
c : of or relating to a mathematical root
d : designed to remove the root of a disease or all diseased and potentially diseased tissue (radical surgery) (radical mastectomy)
2: of or relating to the origin : fundamental
3
a : very different from the usual or traditional : extreme
b : favoring extreme changes in existing views, habits, conditions, or institutions
c : associated with political views, practices, and policies of extreme change
d : advocating extreme measures to retain or restore a political state of affairs (the radical right)
4: slang : excellent, cool
I'm using "radical" as defined in 3a and 3b.
It is one of the characteristics of a free and democratic nation that it have free and independent labor unions. (Franklin D. Roosevelt)
I think that most people view being "radical" the same way they view people who are described as being "extremist." The two words are compatible, but the immediate tendency to put a negative spin on both words is not always correct. These days we're using the words "radical" and "extremist" most often in relation to terrorism and crime, and though the use of the words in that context is entirely appropriate, there are other ways in which to use them that aren't as negative.
Context is very important.
Our country was founded on radical and extremist thoughts, ideas, and actions. If not for a group of people who were willing to do what it takes to achieve an end, the United States of America wouldn't exist.
It's probable that, at the time of the American revolution, the English government thought of the rebels across the pond as radical and extremist. Did our founding fathers see themselves in that light? Probably not. Who's right, and who's wrong?
Both; it depends on what side of the fence you're sitting on. My point is that out of radicalism and extremism, positive things can come to be. Will everyone see the outcome as positive? Of course not. Viewpoint and context color the opinions of all sides.
Conflict is the gadfly of thought. It stirs us to observation and memory. It instigates to invention. It shocks us out of sheep-like passivity, and sets us at noting and contriving. (John Dewey)
There are many types of conflict. There is man versus man, man versus nature, man versus himself, and man versus society (just to name a few basic ones).
There's one type of conflict in which the DME industry has been embroiled for more than a decade, and that's man versus government. In my view, this particular conflict is a complex one, because I see it as a combination of man versus man, man versus himself, and man versus society.
It's frustrating when a conflict is largely one-sided. The industry speaks, protests, and lobbies, but gains no ground because it holds no cards.
Or so we've been led to believe.
True Lies
It's true that the industry holds no cards; it's a lie as well.
I know what you're thinking: Huh?
If the industry plays by the rules and employs the tactics it's adhered to for the last ten-plus years, then it's true that it holds no cards. This has been obvious for many years; the complete lack of progress bears this out.
To those who would argue that the industry has been successful in its fight because round one was delayed for two years, I say this: It's been implemented, and the threat of round two looms quite threateningly. The delay accomplished even lower reimbursements for those in the round-one CBAs, and this bodes very ill for those now facing round two. In short, the delay did more harm than good.
There are no failures - just experiences and your reactions to them. (Tom Krause)
With all due respect, Mr. Krause is basically full of **it. A Pollyanna perspective doesn't make a failure any less of a failure. If you set out to accomplish something and don't get it done, you've failed.
Remember the two benefits of failure. First, if you do fail, you learn what doesn't work; and second, the failure gives you the opportunity to try a new approach. (Roger Von Oech)
Any reasonable person would learn what doesn't work from failure, which would (should) lead to a new approach. It is unfortunate that this hasn't happened to the "leaders" of the DME industry. I've said over and over what the definition of insanity is and how industry leadership is the personification of that definition, so I'm not going to go into that in today's blog.
What I am going to discuss is a new approach.
Tick Tock
We're running out of time. Round two is supposed to start this year. Once that's implemented, I have a sick feeling that we're done for.
We didn't lose the game; we just ran out of time. (Vince Lombardi)
The Industry Strikes Back
The namby-pamby approach used for the last decade hasn't worked. AAHomecare is ineffective. My correspondent was right when he or she said that AAHomecare does not have a clue what to do except to continue to talk to bureaucrats who very clearly aren't listening.
Do not wait to strike till the iron is hot; but make it hot by striking. (William Butler Yeats)
During the original round one and the round-one re-bid, I heard many people saying that the best way to kill competitive bidding would be if no one in the CBAs submitted bids.
This would have been a good tactic, but of course it didn't happen. Some suppliers were motivated by greed (I'm talking to the idiots who submitted the low-ball bids with a winner-take-all mentality) or motivated by fear. It may be cliche, but fear is indeed a great motivator.
They say that absence makes the heart grow fonder. There are people I know I wouldn't miss if they suddenly disappeared, but in general terms, the saying is true.
There's another saying: You don't know what you've got until it's gone. Though this is usually used when discussing love and relationships, it's true in other areas too.
Sometimes in order to teach how important a thing is, a good strategy is to take that thing away. Deprivation is an excellent teaching tool. We use it with our children, don't we?
So what would happen if the DME industry went on strike?
We tell legislators and CMS how important we are. Maybe it's time to show them.
Yes, we feel a responsibility to and for our patients. Forgive me for being entirely pragmatic, but I feel compelled to point out that we didn't take the hippocratic oath. That so many of us are as ethical as we are speaks volumes about the integrity of the people in the industry.
But we are under-valued and under-appreciated. Our importance to care in the home and the money we save the Medicare program is ignored. This is why the years we've spent talking and pleading have fallen on deaf ears.
We protest, but then ultimately submit because our "leaders" have nothing to offer us (I'm talking to you, AAHomecare. I'd be talking to AMEPA and Rob Brant as well if they were of any real value and had any credibility, but they don't.). Industry "leaders" are afraid to employ stronger tactics because the industry might make legislators and agencies angry, but in pussy-footing around, we've only lost ground.
The end result is AAHomecare looking to modify competitive bidding along economists' lines so the program will actually work. If that doesn't shake everyone up I don't know whatwill.
We've told legislators and CMS that we save the Medicare program because our equipment and services prevent emergency room visits. Instead of telling them that, maybe it's time to demonstrate that.
Before everyone gets hysterical and reads more into what I'm saying than is actually there, I'm not advocating harm to patients in any way. The patients are, unfortunately, the innocent victims in the games that CMS plays and our responses to the agency, just as so many of us are the innocent victims of the people who have committed fraud in the industry.
We can handle a strike responsibly. We can inform our patients ahead of time (stressing why we're doing it and that we need their support) and tell them what to do and where to go in the event of a need during a strike (but that the industry will be unable to serve them while the strike is going on).
Our patients need us. The Medicare program needs us. We know that. Telling the government that hasn't worked, so it might be time to show them.
The verdict you pronounce upon the source of your livelihood is the verdict you pronounce upon your life. (Ayn Rand)
I don't accept that the verdict of legislators and CMS on this industry is correct or just.
I haven't looked into the legalities of an organized industry strike; I'm not a lawyer. Strikes are obviously legal on some level; airline pilots, teachers, postal workers, auto workers, and other professionals from other industries have gone on strike. If a union is required to facilitate a strike, then perhaps it's time for the industry to form a union (AAHomecare and Rob Brant need not apply for union leadership, thanks).
I've heard others in the industry make flippant comments about how we should all go on strike, but talking isn't doing, and we need action, not words. Yes, there will be those greedy souls who will try to take advantage of a strike by crossing the figurative picket lines and doing business anyhow. But if enough of us -- most of us -- follow through and flex our collective muscle, we might manage to send a strong message that will give us more bargaining power.
It's Time For a 300
In bowling, strikes are good. This can be true of strikes in industry as well. It's all in how we do what we do, and we need to do something more than what we've been doing.
We need to bowl a 300 if we're going to save the industry. Lucky strike, anyone?
I correspond with some of my readers on a regular basis; I talk with some more than others. In one recent exchange, I said that I had some radical thoughts on tactics for the industry, and the person with whom I was talking said this:
"I think the industry should go in another direction as well and I'd love to hear your radical thoughts. You never know, someone might listen and get other people to listen. The certain fact is that we're dead if something doesn't change and soon. AAHomecare does not have a clue what to do except [continue] to talk to bureaucrats."
Most people are conditioned to think of something radical as being a bad thing. So let's take a look at the word "radical."
rad·i·cal
adj \ˈra-di-kəl\
1: of, relating to, or proceeding from a root: as
a (1) : of or growing from the root of a plant (radical tubers) (2) : growing from the base of a stem, from a rootlike stem, or from a stem that does not rise above the ground (radical leaves)
b : of, relating to, or constituting a linguistic root
c : of or relating to a mathematical root
d : designed to remove the root of a disease or all diseased and potentially diseased tissue (radical surgery) (radical mastectomy)
2: of or relating to the origin : fundamental
3
a : very different from the usual or traditional : extreme
b : favoring extreme changes in existing views, habits, conditions, or institutions
c : associated with political views, practices, and policies of extreme change
d : advocating extreme measures to retain or restore a political state of affairs (the radical right)
4: slang : excellent, cool
I'm using "radical" as defined in 3a and 3b.
It is one of the characteristics of a free and democratic nation that it have free and independent labor unions. (Franklin D. Roosevelt)
I think that most people view being "radical" the same way they view people who are described as being "extremist." The two words are compatible, but the immediate tendency to put a negative spin on both words is not always correct. These days we're using the words "radical" and "extremist" most often in relation to terrorism and crime, and though the use of the words in that context is entirely appropriate, there are other ways in which to use them that aren't as negative.
Context is very important.
Our country was founded on radical and extremist thoughts, ideas, and actions. If not for a group of people who were willing to do what it takes to achieve an end, the United States of America wouldn't exist.
It's probable that, at the time of the American revolution, the English government thought of the rebels across the pond as radical and extremist. Did our founding fathers see themselves in that light? Probably not. Who's right, and who's wrong?
Both; it depends on what side of the fence you're sitting on. My point is that out of radicalism and extremism, positive things can come to be. Will everyone see the outcome as positive? Of course not. Viewpoint and context color the opinions of all sides.
Conflict is the gadfly of thought. It stirs us to observation and memory. It instigates to invention. It shocks us out of sheep-like passivity, and sets us at noting and contriving. (John Dewey)
There are many types of conflict. There is man versus man, man versus nature, man versus himself, and man versus society (just to name a few basic ones).
There's one type of conflict in which the DME industry has been embroiled for more than a decade, and that's man versus government. In my view, this particular conflict is a complex one, because I see it as a combination of man versus man, man versus himself, and man versus society.
It's frustrating when a conflict is largely one-sided. The industry speaks, protests, and lobbies, but gains no ground because it holds no cards.
Or so we've been led to believe.
True Lies
It's true that the industry holds no cards; it's a lie as well.
I know what you're thinking: Huh?
If the industry plays by the rules and employs the tactics it's adhered to for the last ten-plus years, then it's true that it holds no cards. This has been obvious for many years; the complete lack of progress bears this out.
To those who would argue that the industry has been successful in its fight because round one was delayed for two years, I say this: It's been implemented, and the threat of round two looms quite threateningly. The delay accomplished even lower reimbursements for those in the round-one CBAs, and this bodes very ill for those now facing round two. In short, the delay did more harm than good.
There are no failures - just experiences and your reactions to them. (Tom Krause)
With all due respect, Mr. Krause is basically full of **it. A Pollyanna perspective doesn't make a failure any less of a failure. If you set out to accomplish something and don't get it done, you've failed.
Remember the two benefits of failure. First, if you do fail, you learn what doesn't work; and second, the failure gives you the opportunity to try a new approach. (Roger Von Oech)
Any reasonable person would learn what doesn't work from failure, which would (should) lead to a new approach. It is unfortunate that this hasn't happened to the "leaders" of the DME industry. I've said over and over what the definition of insanity is and how industry leadership is the personification of that definition, so I'm not going to go into that in today's blog.
What I am going to discuss is a new approach.
Tick Tock
We're running out of time. Round two is supposed to start this year. Once that's implemented, I have a sick feeling that we're done for.
We didn't lose the game; we just ran out of time. (Vince Lombardi)
The Industry Strikes Back
The namby-pamby approach used for the last decade hasn't worked. AAHomecare is ineffective. My correspondent was right when he or she said that AAHomecare does not have a clue what to do except to continue to talk to bureaucrats who very clearly aren't listening.
Do not wait to strike till the iron is hot; but make it hot by striking. (William Butler Yeats)
During the original round one and the round-one re-bid, I heard many people saying that the best way to kill competitive bidding would be if no one in the CBAs submitted bids.
This would have been a good tactic, but of course it didn't happen. Some suppliers were motivated by greed (I'm talking to the idiots who submitted the low-ball bids with a winner-take-all mentality) or motivated by fear. It may be cliche, but fear is indeed a great motivator.
They say that absence makes the heart grow fonder. There are people I know I wouldn't miss if they suddenly disappeared, but in general terms, the saying is true.
There's another saying: You don't know what you've got until it's gone. Though this is usually used when discussing love and relationships, it's true in other areas too.
Sometimes in order to teach how important a thing is, a good strategy is to take that thing away. Deprivation is an excellent teaching tool. We use it with our children, don't we?
So what would happen if the DME industry went on strike?
We tell legislators and CMS how important we are. Maybe it's time to show them.
Yes, we feel a responsibility to and for our patients. Forgive me for being entirely pragmatic, but I feel compelled to point out that we didn't take the hippocratic oath. That so many of us are as ethical as we are speaks volumes about the integrity of the people in the industry.
But we are under-valued and under-appreciated. Our importance to care in the home and the money we save the Medicare program is ignored. This is why the years we've spent talking and pleading have fallen on deaf ears.
We protest, but then ultimately submit because our "leaders" have nothing to offer us (I'm talking to you, AAHomecare. I'd be talking to AMEPA and Rob Brant as well if they were of any real value and had any credibility, but they don't.). Industry "leaders" are afraid to employ stronger tactics because the industry might make legislators and agencies angry, but in pussy-footing around, we've only lost ground.
The end result is AAHomecare looking to modify competitive bidding along economists' lines so the program will actually work. If that doesn't shake everyone up I don't know what
We've told legislators and CMS that we save the Medicare program because our equipment and services prevent emergency room visits. Instead of telling them that, maybe it's time to demonstrate that.
Before everyone gets hysterical and reads more into what I'm saying than is actually there, I'm not advocating harm to patients in any way. The patients are, unfortunately, the innocent victims in the games that CMS plays and our responses to the agency, just as so many of us are the innocent victims of the people who have committed fraud in the industry.
We can handle a strike responsibly. We can inform our patients ahead of time (stressing why we're doing it and that we need their support) and tell them what to do and where to go in the event of a need during a strike (but that the industry will be unable to serve them while the strike is going on).
Our patients need us. The Medicare program needs us. We know that. Telling the government that hasn't worked, so it might be time to show them.
The verdict you pronounce upon the source of your livelihood is the verdict you pronounce upon your life. (Ayn Rand)
I don't accept that the verdict of legislators and CMS on this industry is correct or just.
I haven't looked into the legalities of an organized industry strike; I'm not a lawyer. Strikes are obviously legal on some level; airline pilots, teachers, postal workers, auto workers, and other professionals from other industries have gone on strike. If a union is required to facilitate a strike, then perhaps it's time for the industry to form a union (AAHomecare and Rob Brant need not apply for union leadership, thanks).
I've heard others in the industry make flippant comments about how we should all go on strike, but talking isn't doing, and we need action, not words. Yes, there will be those greedy souls who will try to take advantage of a strike by crossing the figurative picket lines and doing business anyhow. But if enough of us -- most of us -- follow through and flex our collective muscle, we might manage to send a strong message that will give us more bargaining power.
It's Time For a 300
In bowling, strikes are good. This can be true of strikes in industry as well. It's all in how we do what we do, and we need to do something more than what we've been doing.
We need to bowl a 300 if we're going to save the industry. Lucky strike, anyone?
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